1134676000 NPI number — PROFLEX PHYSICAL THERAPY OF MARYLAND, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134676000 NPI number — PROFLEX PHYSICAL THERAPY OF MARYLAND, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFLEX PHYSICAL THERAPY OF MARYLAND, 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:
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:
1134676000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 SAINT PATRICKS DR
Provider Second Line Business Mailing Address:
401
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20603-4527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-870-7366
Provider Business Mailing Address Fax Number:
301-870-6717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 RANDOLPH RD
Provider Second Line Business Practice Location Address:
105
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-990-9599
Provider Business Practice Location Address Fax Number:
240-221-0023
Provider Enumeration Date:
09/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HEIER
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
301-932-4785

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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