Provider Demographics
NPI:1083783583
Name:GEORGE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GEORGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANU
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-383-6665
Mailing Address - Street 1:PO BOX 6281
Mailing Address - Street 2:GEORGE PHYSICAL THERAPY
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21094
Mailing Address - Country:US
Mailing Address - Phone:410-383-6665
Mailing Address - Fax:410-383-6778
Practice Address - Street 1:2614 PENNSYLVANIA AVE STE A&B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1877
Practice Address - Country:US
Practice Address - Phone:410-383-6665
Practice Address - Fax:410-383-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD281106501Medicaid
MD281106501Medicaid