1134176852 NPI number — WELLNESS WORKS PHYSICAL THERAPY INC

Table of content: (NPI 1134176852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134176852 NPI number — WELLNESS WORKS PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLNESS WORKS PHYSICAL THERAPY 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:
1134176852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10207 SOUTH DOLFIELD ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-3607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-902-5997
Provider Business Mailing Address Fax Number:
410-902-5776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10207 SOUTH DOLFIELD ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-902-5997
Provider Business Practice Location Address Fax Number:
410-902-5776
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
410-902-5997

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  16517 , 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: N183 . This is a "CARE FIRST BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 637CWE . This is a "CARE FIRST BCBS" identifier . This identifiers is of the category "OTHER".




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