MEDICARE: SKY THERAPY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1912528803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKY THERAPY, LLC

Provider Business Mailing Address
First Line	:	6608 WICKFIELD RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-2532
Country	:	US
Telephone Number	:	917-449-5956
Fax Number	:

Provider Business Practice Location Address
First Line	:	6608 WICKFIELD RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-2532
Country	:	US
Telephone Number	:	917-449-5956
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KHEMDA NOURMAND
Credential	:
Telephone Number	:	917-449-5956

Provider Enumeration Date	:	05/01/2020
Last Update Date	:	05/01/2020

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Directions to “SKY THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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