Basic Information
| Provider Information | |||||||||
| NPI: | 1245882224 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | 4 OAKS PHYSICAL THERAPY OF HARFORD COUNTY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | 4 OAKS PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 SCHILLING RD STE LL3 | ||||||||
| Address2: | |||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210318644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102299800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9 SCHILLING RD STE LL3 | ||||||||
| Address2: | |||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210318644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102299800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2019 | ||||||||
| LastUpdateDate: | 09/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | WALLICK | ||||||||
| AuthorizedOfficialFirstName: | JEREMY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7864755174 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.