1710426697 NPI number — CRK, LLC.

Table of content: (NPI 1710426697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710426697 NPI number — CRK, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRK, 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:
ELITE CARE PHYSICAL THERAPY AT CHESAPEAKE BEACH
Provider Other Organization Name Type Code:
3
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:
1710426697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 978
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE BEACH
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8501 BAYSIDE ROAD
Provider Second Line Business Practice Location Address:
SUITE C 4
Provider Business Practice Location Address City Name:
CHESAPEAKE BEACH
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20732-8501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-299-4686
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KNIGHT
Authorized Official First Name:
ROSALEA
Authorized Official Middle Name:
Authorized Official Title or Position:
PART OWNER/ PHYSICAL THERAPIST
Authorized Official Telephone Number:
240-299-4686

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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)





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