1730479015 NPI number — ON DEMAND PT, INC.

Table of content: (NPI 1730479015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730479015 NPI number — ON DEMAND PT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ON DEMAND PT, 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:
1730479015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24728 RED MAPLE RD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCCOOLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21562-2233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-291-1429
Provider Business Mailing Address Fax Number:
610-300-3200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24728 RED MAPLE RD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCCOOLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21562-2233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-291-1429
Provider Business Practice Location Address Fax Number:
610-300-3200
Provider Enumeration Date:
04/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
240-291-1429

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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