Provider Demographics
NPI:1174699698
Name:PROFESSIONAL HEALTH STAFFING OF MARYLAND
Entity type:Organization
Organization Name:PROFESSIONAL HEALTH STAFFING OF MARYLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LOCATI-BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:410-771-6868
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EP 1 SUITE 503
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:410-771-6868
Mailing Address - Fax:410-771-8444
Practice Address - Street 1:11350 MCCORMICK RD
Practice Address - Street 2:EP 1 SUITE 503
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1002
Practice Address - Country:US
Practice Address - Phone:410-771-6868
Practice Address - Fax:410-771-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy