Basic Information
| Provider Information | |||||||||
| NPI: | 1811537814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AGAPE PHYSICAL THERAPY & SPORTS REHABILITATION LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 NEWPORT DR STE A | ||||||||
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| City: | FOREST HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210501758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108389600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5301 CAMPBELL BLVD | ||||||||
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| City: | NOTTINGHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212365029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109339800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2020 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | BINSTEIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7132977000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/08/2020 | ||||||||
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.