Provider Demographics
NPI:1255846184
Name:HARBORSIDE PHYSICAL THERAPY AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:HARBORSIDE PHYSICAL THERAPY AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIENDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:240-244-5614
Mailing Address - Street 1:7801 OLD BRANCH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1642
Mailing Address - Country:US
Mailing Address - Phone:240-244-5614
Mailing Address - Fax:240-348-4133
Practice Address - Street 1:7801 OLD BRANCH AVE STE 203
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1642
Practice Address - Country:US
Practice Address - Phone:240-244-5614
Practice Address - Fax:240-348-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty