Provider Demographics
NPI:1114047248
Name:GARRETT, WILLIAM BERNARD (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BERNARD
Last Name:GARRETT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 N CHARLES ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4627
Mailing Address - Country:US
Mailing Address - Phone:410-889-7872
Mailing Address - Fax:410-889-7992
Practice Address - Street 1:2530 N CHARLES ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4627
Practice Address - Country:US
Practice Address - Phone:410-889-7872
Practice Address - Fax:410-889-7992
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0003W486OtherCAREFIRST BLUE CROSS
MD52676201OtherCAREFIRST BLUE CROSS
MD1218158500Medicaid
DC0003W486OtherCAREFIRST BLUE CROSS