1437233491 NPI number — SEVERNA PARK PHYSICAL THERAPY INC.

Table of content: (NPI 1437233491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437233491 NPI number — SEVERNA PARK PHYSICAL THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEVERNA PARK 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:
1437233491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
248 EARECKSON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVENSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21666-3040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-643-0877
Provider Business Mailing Address Fax Number:
410-643-1175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
844 RITCHIE HWY
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
SEVERNA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21146-4127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-544-0773
Provider Business Practice Location Address Fax Number:
410-544-0774
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VANWIE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
301-346-2657

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  15365 , 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)





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