Basic Information
| Provider Information | |||||||||
| NPI: | 1336290063 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 FAIRMOUNT AVE | ||||||||
| Address2: | STE 302 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212865494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109278768 | ||||||||
| FaxNumber: | 4106484878 | ||||||||
| Practice Location | |||||||||
| Address1: | 2977 MANCHESTER RD | ||||||||
| Address2: | STE A | ||||||||
| City: | MANCHESTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211021802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103748410 | ||||||||
| FaxNumber: | 4103748409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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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 | 208100000X | 19451 | MD | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225100000X | 19451 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 47610189 | 01 | CAREFIRST BCBS PROVIDER # | OTHER | 69772203 | 01 | MD | BCBS REGION RENDERING # | OTHER | 44565 | 01 | IWIF PROVIDER NUMBER | OTHER | 310822 | 01 | MDIPA, MAMSI, OPT CHOICE | OTHER | 7647074 | 01 | AETNA PROVIDER NUMBER | OTHER | 310822 | 01 | ALLIANCE PROVIDER NUMBER | OTHER | 023348001 | 05 | MD | MEDICAID | 1939107 | 01 | UNITEDHEALTHCARE PROVIDER | OTHER |