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NPI Code Detail

MEDICARE: CHESAPEAKE PHYSICAL AQUATIC THERAPY INC

MEDICARE: CHESAPEAKE PHYSICAL AQUATIC THERAPY INC
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
12251S0007XSports Physical Therapist
22251X0800XOrthopedic Physical Therapist
3225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1S429OTHERDCBLUE CROSS BLUE SHIELD
2KBX3OTHERMDBLUE SHIELD MD PROVIDER#

General Provider Information

NPI Number : 1639223381
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHESAPEAKE PHYSICAL AQUATIC THERAPY INC
Provider Business Mailing Address
First Line : 314 MARSHALL AVE
Second Line :
City : LAUREL
State : MD
Zip : 20707-4823
Country : US
Telephone Number : 301-262-5852
Fax Number : 301-262-3173
Provider Business Practice Location Address
First Line : 100 WHITE MARSH PARK DR
Second Line :
City : BOWIE
State : MD
Zip : 20715-4361
Country : US
Telephone Number : 301-262-5852
Fax Number : 301-262-3173
Authorized Official
Title or Position : OWNER
Name : MR. JARED STEWART GOLDSTEIN
Credential : P.T.
Telephone Number : 301-262-5852
Provider Enumeration Date : 01/22/2007
Last Update Date : 12/19/2008

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Directions to “CHESAPEAKE PHYSICAL AQUATIC THERAPY INC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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