Provider Demographics
NPI:1326084237
Name:MUTSCHLER, CHARLES A (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:MUTSCHLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FAIRMOUNT AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5457
Mailing Address - Country:US
Mailing Address - Phone:410-927-8768
Mailing Address - Fax:
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:302
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:410-768-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1679630073OtherFACILITY NPI NUMBER
MDF8710105OtherCAREFIRST
MD122047OtherJOHNS HOPKINS
1366307OtherAMERIGROUP
MD091166600Medicaid
MD283M380FOtherPTAN, MEDICARE
MDF7170001OtherCAREFIRST
MD396920YQ1ROtherMEDICARE PTAN
MD396920YT8OtherMEDICARE PTAN
5398714OtherAETNA
MD426681ZBEWOtherMEDICARE PTAN
MD51200024OtherCAREFIRST
MDP650023224OtherMEDICARE RR