1609972454 NPI number — OCEAN PHYSICAL THERAPY & SPORTS MEDICINE, INC

Table of content: KENNETH JOSEPH HARWOOD PT, PHD, CIE (NPI 1902022593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609972454 NPI number — OCEAN PHYSICAL THERAPY & SPORTS MEDICINE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN PHYSICAL THERAPY & 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:
1609972454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 FRANKLIN AVE
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21811-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-641-0999
Provider Business Mailing Address Fax Number:
410-641-9576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-641-0999
Provider Business Practice Location Address Fax Number:
410-641-9576
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAKOWSKI
Authorized Official First Name:
ALICE
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
410-641-0999

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: KS11 . This is a "BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 229758200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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