Basic Information
| Provider Information | |||||||||
| NPI: | 1356884449 | ||||||||
| 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 STE 4 | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218119344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102083630 | ||||||||
| FaxNumber: | 4102083633 | ||||||||
| Practice Location | |||||||||
| Address1: | 1406 S SALISBURY BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218017162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437364091 | ||||||||
| FaxNumber: | 4437364358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2016 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | CUMMINGS | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CORPORATE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4102083630 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 713M | 01 | MD | MEDICARE PTAN | OTHER |