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General NPI Number Information
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NPI Number | 1629699293
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Entity Type | Organization
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Legal Business Name | SOVEREIGNTY HEALTH SERVICES LLC
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 5310 OLD COURT RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5243
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Country | US
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Telephone | 410-940-1983
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Fax |
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Provider Business Mailing Address
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Address Line | 152 SPECTATOR LN
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4444
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Country | US
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Telephone | 410-940-1983
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Fax |
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Authorized Official
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Title or Position | OTR/L
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Name | KEHINDE TIJANI
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Credential |
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Telephone | 410-940-1983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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