1750311908 NPI number — PATTERSON PHYSICAL THERAPY INC

Table of content: (NPI 1750311908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750311908 NPI number — PATTERSON PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATTERSON PHYSICAL THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750311908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 RITCHIE HWY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SEVERNA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21146-3916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-647-1961
Provider Business Mailing Address Fax Number:
410-647-8276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 RITCHIE HWY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SEVERNA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21146-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-647-1961
Provider Business Practice Location Address Fax Number:
410-647-8276
Provider Enumeration Date:
07/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATTERSON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
410-647-1961

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  16229 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 16203 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N126-0003 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89575801 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 52908331 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: N126-0001 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 52100440 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: N126-0002 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".