Basic Information
| Provider Information | |||||||||
| NPI: | 1053487470 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHYSIOTHERAPY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 598 CRANBROOK RD | ||||||||
| Address2: | |||||||||
| City: | COCKEYSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210303702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106834515 | ||||||||
| FaxNumber: | 4106834058 | ||||||||
| Practice Location | |||||||||
| Address1: | 598 CRANBROOK RD | ||||||||
| Address2: | |||||||||
| City: | COCKEYSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210303702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106834515 | ||||||||
| FaxNumber: | 4106834058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PIERCE | ||||||||
| AuthorizedOfficialFirstName: | COLLEEN | ||||||||
| AuthorizedOfficialMiddleName: | MEDLIN | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC DIRECTOR PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4106834515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MSPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 20605 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.