Provider Demographics
NPI:1164622643
Name:SALISBURY MUSCULOSKELETAL CLINIC
Entity Type:Organization
Organization Name:SALISBURY MUSCULOSKELETAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-341-6520
Mailing Address - Street 1:32071 BEAVER RUN DR STE B
Mailing Address - Street 2:P.O. BOX 1859
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1773
Mailing Address - Country:US
Mailing Address - Phone:410-341-6520
Mailing Address - Fax:410-341-6526
Practice Address - Street 1:32071 BEAVER RUN DR STE B
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1773
Practice Address - Country:US
Practice Address - Phone:410-341-6520
Practice Address - Fax:410-341-6526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDQ00754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD628FMedicare PIN