=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710954524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEREFORD PHYSICAL THERAPY & SPORTS MEDICINE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 MOUNT CARMEL RD
-----------------------------------------------------
City | PARKTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21120-9721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-229-0055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 MOUNT CARMEL RD
-----------------------------------------------------
City | PARKTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21120-9721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-229-0055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. STEVE KINSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-229-0055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------