Provider Demographics
NPI:1508068255
Name:CHESAPEAKE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CHESAPEAKE PHYSICAL THERAPY, LLC
Other - Org Name:KATY MULLIGAN WEDDELL, P.T.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-778-3900
Mailing Address - Street 1:210 S CROSS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1569
Mailing Address - Country:US
Mailing Address - Phone:410-778-3900
Mailing Address - Fax:
Practice Address - Street 1:210 S CROSS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1569
Practice Address - Country:US
Practice Address - Phone:410-778-3900
Practice Address - Fax:410-778-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2014-02-28
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
MD531PMedicare PIN