MEDICARE: PROFLEX PHYSICAL THERAPY OF MARYLAND, 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1497263578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFLEX PHYSICAL THERAPY OF MARYLAND, LLC

Provider Business Mailing Address
First Line	:	PO BOX 791217
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21279-1217
Country	:	US
Telephone Number	:	301-932-4786
Fax Number	:	301-932-4789

Provider Business Practice Location Address
First Line	:	22738 MAPLE RD STE 102
Second Line	:
City	:	LEXINGTON PARK
State	:	MD
Zip	:	20653-3347
Country	:	US
Telephone Number	:	301-363-0539
Fax Number	:	301-363-4794

Authorized Official
Title or Position	:	DIRECTOR OF BILLING
Name	:	KATHY HEIER
Credential	:
Telephone Number	:	301-932-4785

Provider Enumeration Date	:	01/11/2018
Last Update Date	:	09/19/2022

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