1710207709 NPI number — SOUTHERN MARYLAND PHYSICAL THERAPY INC.

Table of content: (NPI 1710207709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710207709 NPI number — SOUTHERN MARYLAND PHYSICAL THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN MARYLAND 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:
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:
1710207709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7503 SURRATTS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-3358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-870-7001
Provider Business Mailing Address Fax Number:
301-870-6697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23000 MOAKLEY ST
Provider Second Line Business Practice Location Address:
SUITE #102
Provider Business Practice Location Address City Name:
LEONARDTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20650-2915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-997-0172
Provider Business Practice Location Address Fax Number:
301-997-0175
Provider Enumeration Date:
06/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHIARMONTE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-877-4530

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 219378700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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