Basic Information
| Provider Information | |||||||||
| NPI: | 1417009408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYSIDE PHYSICAL THERAPY AND SPORTS REHABILITATION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3179 BRAVERTON ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | EDGEWATER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210372665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109564308 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8601 VETERANS HWY | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211081547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109872162 | ||||||||
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| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FORD | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4109564308 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.