Basic Information
| Provider Information | |||||||||
| NPI: | 1326084237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUTSCHLER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 FAIRMOUNT AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212865457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109278768 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 CRAIN HWY S | ||||||||
| Address2: | 302 | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210615577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107681213 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 10/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 18819 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1679630073 | 01 | MD | FACILITY NPI NUMBER | OTHER | F8710105 | 01 | MD | CAREFIRST | OTHER | 122047 | 01 | MD | JOHNS HOPKINS | OTHER | 1366307 | 01 | AMERIGROUP | OTHER | 091166600 | 05 | MD | MEDICAID | 283M380F | 01 | MD | PTAN, MEDICARE | OTHER | F7170001 | 01 | MD | CAREFIRST | OTHER | 396920YQ1R | 01 | MD | MEDICARE PTAN | OTHER | 396920YT8 | 01 | MD | MEDICARE PTAN | OTHER | 5398714 | 01 | AETNA | OTHER | 426681ZBEW | 01 | MD | MEDICARE PTAN | OTHER | 51200024 | 01 | MD | CAREFIRST | OTHER | P650023224 | 01 | MD | MEDICARE RR | OTHER |