1982055323 NPI number — PHOENIX PHYSICAL THERAPY AND FITNESS

Table of content: (NPI 1982055323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982055323 NPI number — PHOENIX PHYSICAL THERAPY AND FITNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX PHYSICAL THERAPY AND FITNESS
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:
1982055323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3610 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BEACH
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20714-3010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 W DARES BEACH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCE FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20678-3150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-610-4275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HUNSICKER
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST/OWNER
Authorized Official Telephone Number:
410-610-4275

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  24263 , 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)





Copyright © 2007-2025 www.npivalidator.com