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General NPI Number Information
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NPI Number | 1407441025
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Entity Type | Organization
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Legal Business Name | PERSONALIZED PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 1507 RITCHIE HWY SUITE 101
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City | ARNOLD
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State | MD
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Zip | 21012
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Country | US
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Telephone | 302-345-7202
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Fax |
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Provider Business Mailing Address
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Address Line | 1507 RITCHIE HWY SUITE 101
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City | ARNOLD
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State | MD
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Zip | 21012
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Country | US
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Telephone | 302-345-7202
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | KELSEY VAGNONI
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Credential | DPT
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Telephone | 302-345-7202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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