Provider Demographics
NPI:1275687535
Name:CHESAPEAKE PHYSICAL & AQUATIC THERAPY
Entity Type:Organization
Organization Name:CHESAPEAKE PHYSICAL & AQUATIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-381-7000
Mailing Address - Street 1:13946 BALTIMORE AVE.
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-498-2212
Mailing Address - Fax:301-498-2213
Practice Address - Street 1:13946 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5000
Practice Address - Country:US
Practice Address - Phone:301-498-2212
Practice Address - Fax:301-498-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKBX3OtherBLUE CROSS MD PROVIDER #
MDS429OtherBLUE CROSS DC PROVIDER #
MDKBX3OtherBLUE CROSS MD PROVIDER #