Provider Demographics
NPI:1003031923
Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:KANS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:301-645-6680
Mailing Address - Street 1:10665 STANHAVEN PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3060
Mailing Address - Country:US
Mailing Address - Phone:301-645-6680
Mailing Address - Fax:301-645-5363
Practice Address - Street 1:10665 STANHAVEN PL
Practice Address - Street 2:SUITE 103
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3060
Practice Address - Country:US
Practice Address - Phone:301-645-6680
Practice Address - Fax:301-645-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK7590001OtherCAREFIRST DC
MD1064250OtherAETNA
MDK7590001OtherBLUE CROSS FEDERAL
MD60906402OtherCAREFIRST
MD2140256OtherUNITED HEALTHCARE
MD2140256OtherUNITED HEALTHCARE