Provider Demographics
NPI:1275684185
Name:KENILWORTH THERAPEUTIC SERVICES, INC.
Entity Type:Organization
Organization Name:KENILWORTH THERAPEUTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SCHRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-345-5687
Mailing Address - Street 1:7745 BELLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3316
Mailing Address - Country:US
Mailing Address - Phone:301-345-5687
Mailing Address - Fax:301-345-5881
Practice Address - Street 1:7745 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3316
Practice Address - Country:US
Practice Address - Phone:301-345-5687
Practice Address - Fax:301-345-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD288620Medicare ID - Type Unspecified