Provider Demographics
NPI:1033125604
Name:FEEHLEY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:FEEHLEY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:FEEHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-812-0170
Mailing Address - Street 1:4807 BART ALLEN LN
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9769
Mailing Address - Country:US
Mailing Address - Phone:410-817-4697
Mailing Address - Fax:
Practice Address - Street 1:8813 WALTHAM WOODS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-2450
Practice Address - Country:US
Practice Address - Phone:410-812-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16255261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD218705970OtherSS#
MD=========OtherTAX I D#