1487805685 NPI number — HAILE PHYSICAL THERAPY LLC

Table of content: (NPI 1487805685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487805685 NPI number — HAILE PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAILE PHYSICAL THERAPY LLC
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:
1487805685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 AMESBURY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEVERNA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21146-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-647-7326
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2152 RENARD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-6756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-571-1151
Provider Business Practice Location Address Fax Number:
410-266-1513
Provider Enumeration Date:
10/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HAILE
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-571-1151

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 16024 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053539601 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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