Provider Demographics
NPI:1356473318
Name:EASTERN SHORE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EASTERN SHORE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-641-2900
Mailing Address - Street 1:314 FRANKLIN AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1263
Mailing Address - Country:US
Mailing Address - Phone:410-641-2900
Mailing Address - Fax:410-641-2914
Practice Address - Street 1:314 FRANKLIN AVE STE 405
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1263
Practice Address - Country:US
Practice Address - Phone:410-641-2900
Practice Address - Fax:410-641-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18883225100000X
MD19301225100000X
MDA2461225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402788400Medicaid
MD551MMedicare ID - Type UnspecifiedOFFICE NUMBER
MD402788400Medicaid