MEDICARE: 4 OAKS PHYSICAL THERAPY, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	19806	MD

General Provider Information

NPI Number	:	1144637570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4 OAKS PHYSICAL THERAPY, LLC.

Provider Business Mailing Address
First Line	:	PO BOX 52405
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85072-2405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10632 LITTLE PATUXENT PKWY
Second Line	:	SUITE 123
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3273
Country	:	US
Telephone Number	:	443-917-2973
Fax Number	:	443-917-2983

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	ANNA GAYLORD
Credential	:
Telephone Number	:	678-837-7176

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	01/07/2026

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