Basic Information
| Provider Information | |||||||||
| NPI: | 1841569803 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHARLES SCLATER PHYSICAL THERAPY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAYVIEW PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8501 BAYSIDE RD | ||||||||
| Address2: | UNIT C4 | ||||||||
| City: | CHESAPEAKE BEACH | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207323313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439645656 | ||||||||
| FaxNumber: | 4439645657 | ||||||||
| Practice Location | |||||||||
| Address1: | 8501 BAYSIDE RD | ||||||||
| Address2: | UNIT C4 | ||||||||
| City: | CHESAPEAKE BEACH | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207323350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439645656 | ||||||||
| FaxNumber: | 4439645657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2011 | ||||||||
| LastUpdateDate: | 02/27/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCLATER | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4439645656 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 20886 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.