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General NPI Number Information
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NPI Number | 1427306588
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Entity Type | Organization
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Legal Business Name | 1ST CHOICE PT, LLC
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 1533 MEMORIAL DR
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City | OAKLAND
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State | MD
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Zip | 21550-4338
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Country | US
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Telephone | 301-616-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 1533 MEMORIAL DR
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City | OAKLAND
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State | MD
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Zip | 21550-4338
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Country | US
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Telephone | 301-616-2919
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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 | MS. AUDREY JEAN KENNEDY
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Credential | MED, PT
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Telephone | 301-616-2919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 18757
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License Number State | MD
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