1164641437 NPI number — SALISBURY PHYSICAL THERAPY & SPORTSMEDICINE

Table of content: (NPI 1164641437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164641437 NPI number — SALISBURY PHYSICAL THERAPY & SPORTSMEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALISBURY PHYSICAL THERAPY & SPORTSMEDICINE
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:
6
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:
1164641437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
949 MOUNT HERMON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-5105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-543-9000
Provider Business Mailing Address Fax Number:
410-543-9033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 10TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
POCOMOKE CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21851-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-543-9000
Provider Business Practice Location Address Fax Number:
410-543-9033
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MASSEY
Authorized Official First Name:
MARY ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
410-543-9000

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  15888 , 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: 071378301 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 328A . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S402 . This is a "FEDERAL BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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