Basic Information
| Provider Information | |||||||||
| NPI: | 1124117916 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC PHYSICAL THERAPY REHABILITATION AND SPORTS MEDICINE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11070 CATHELL RD | ||||||||
| Address2: | UNIT 4 | ||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218119344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102083630 | ||||||||
| FaxNumber: | 4102083632 | ||||||||
| Practice Location | |||||||||
| Address1: | 11070 CATHELL RD | ||||||||
| Address2: | UNIT 4 | ||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218119344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102083630 | ||||||||
| FaxNumber: | 4102083632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 11/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | CUMMINGS | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4102083630 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 2251X0800X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 9000709DE | 01 | DE | DELAWARE BLUE CROSS GROUP | OTHER | J564 | 01 | MD | BLUE CHOICE GROUP # | OTHER | 754A | 01 | MD | CAREFIRST GROUP # | OTHER | G02084 | 01 | DE | MEDICARE GROUP # | OTHER |