Provider Demographics
NPI:1437559580
Name:PHYSIOTHERAPY CORPORATION
Entity Type:Organization
Organization Name:PHYSIOTHERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-7824
Mailing Address - Street 1:4924 CAMPBELL BLVD
Mailing Address - Street 2:SUITE 130A
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5908
Mailing Address - Country:US
Mailing Address - Phone:610-884-4814
Mailing Address - Fax:
Practice Address - Street 1:4924 CAMPBELL BLVD
Practice Address - Street 2:SUITE 130A
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5908
Practice Address - Country:US
Practice Address - Phone:610-884-4814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21190261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3503195000OtherIBC AMERIHEALTH
MD216512OtherMEDICARE ID
11779850OtherCAQH
3503195000OtherAMERIHEALTH
50700047OtherCAREFIRST
1245244938OtherCHAMPUST
88760514OtherNCA
MD216512OtherMEDICARE ID