1194879858 NPI number — ATLANTIC PHYSICAL THERAPY AND REHAB CENTER LTD

Table of content: (NPI 1194879858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194879858 NPI number — ATLANTIC PHYSICAL THERAPY AND REHAB CENTER LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC PHYSICAL THERAPY AND REHAB CENTER LTD
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:
1194879858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13975 CONNECTICUT AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20906-2921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-598-7420
Provider Business Mailing Address Fax Number:
301-598-7432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13975 CONNECTICUT AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20906-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-598-7420
Provider Business Practice Location Address Fax Number:
301-598-7432
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STURM
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-598-7420

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7751010 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: S986000 . This is a "CF BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 683203200 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: LK24AT . This is a "CF BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 338063 . This is a "MAMSI LIFE MD IPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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