Basic Information
| Provider Information | |||||||||
| NPI: | 1982214490 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LHMG PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 MEDICAL PKWY | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434815618 | ||||||||
| FaxNumber: | 4434814151 | ||||||||
| Practice Location | |||||||||
| Address1: | 7611 CRAIN HWY # C170 | ||||||||
| Address2: | |||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207724258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811140 | ||||||||
| FaxNumber: | 4107294526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2020 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | ODENWALD | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT-PHYSICIAN SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4434816415 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 454595 | 01 | MD | MEDICARE | OTHER |