1851774475 NPI number — FELICE PHYSICAL THERAPY

Table of content: (NPI 1851774475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851774475 NPI number — FELICE PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FELICE PHYSICAL THERAPY
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:
1851774475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3190 LAWNDALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FINKSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21048-1565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-408-8341
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11270 PEPPER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNT VALLEY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21031-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-408-8341
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FELICE
Authorized Official First Name:
JEROD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
315-408-8341

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  22634 , 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)