Basic Information
| Provider Information | |||||||||
| NPI: | 1295262962 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESAPEAKE BAY AQUATIC & PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4058 | ||||||||
| Address2: | |||||||||
| City: | CROFTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211144058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103159080 | ||||||||
| FaxNumber: | 4103159012 | ||||||||
| Practice Location | |||||||||
| Address1: | 1412 SHOEMAKER RD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212092009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103159080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2017 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4103159080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.