Provider Demographics
NPI:1003064627
Name:CHESAPEAKE LYMPHEDEMA AND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CHESAPEAKE LYMPHEDEMA AND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:BRUNETTO
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, CLT
Authorized Official - Phone:443-510-2932
Mailing Address - Street 1:3212 CHRISLAND DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4350
Mailing Address - Country:US
Mailing Address - Phone:443-510-2932
Mailing Address - Fax:
Practice Address - Street 1:3212 CHRISLAND DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-4350
Practice Address - Country:US
Practice Address - Phone:443-510-2932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty