1003031923 NPI number — ORTHOPEDIC & SPORTS PHYSICAL THERAPY

Table of content: (NPI 1003031923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003031923 NPI number — ORTHOPEDIC & SPORTS PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC & SPORTS 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:
1003031923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10665 STANHAVEN PL
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20695-3060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-645-6680
Provider Business Mailing Address Fax Number:
301-645-5363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10665 STANHAVEN PL
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20695-3060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-645-6680
Provider Business Practice Location Address Fax Number:
301-645-5363
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KANS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-645-6680

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  19798 , 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: K7590001 . This is a "CAREFIRST DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1064250 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: K7590001 . This is a "BLUE CROSS FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 60906402 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2140256 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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