MEDICARE: CALVERT PHYSICAL THERAPY AND SPORTS FITNESS CENTER

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	332B00000X	Durable Medical Equipment & Medical Supplies	15757	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457502569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVERT PHYSICAL THERAPY AND SPORTS FITNESS CENTER

Provider Business Mailing Address
First Line	:	120 HOSPITAL RD
Second Line	:	SUITE 100
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4022
Country	:	US
Telephone Number	:	410-535-8180
Fax Number	:	410-535-8325

Provider Business Practice Location Address
First Line	:	8501 BAYSIDE RD
Second Line	:	SUITE C4
City	:	CHESAPEAKE BEACH
State	:	MD
Zip	:	20732-3350
Country	:	US
Telephone Number	:	410-286-2504
Fax Number	:	410-286-2506

Authorized Official
Title or Position	:	MANAGER OF OPERATIONS
Name	:	MRS. DEBORAH J SMOOTZ
Credential	:
Telephone Number	:	410-414-4846

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/07/2008

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