1124117916 NPI number — ATLANTIC PHYSICAL THERAPY REHABILITATION AND SPORTS MEDICINE INC

Table of content: (NPI 1124117916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124117916 NPI number — ATLANTIC PHYSICAL THERAPY REHABILITATION AND SPORTS MEDICINE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC PHYSICAL THERAPY REHABILITATION AND SPORTS MEDICINE INC
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:
1124117916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11070 CATHELL RD
Provider Second Line Business Mailing Address:
UNIT 4
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21811-9344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-208-3630
Provider Business Mailing Address Fax Number:
410-208-3632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11070 CATHELL RD
Provider Second Line Business Practice Location Address:
UNIT 4
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811-9344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-208-3630
Provider Business Practice Location Address Fax Number:
410-208-3632
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINGS
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
410-208-3630

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9000709DE . This is a "DELAWARE BLUE CROSS GROUP" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: J564 . This is a "BLUE CHOICE GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 754A . This is a "CAREFIRST GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: G02084 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com