Provider Demographics
NPI:1518087279
Name:PHYSICAL THERAPY CONNECTION, INC.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CONNECTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:410-751-6858
Mailing Address - Street 1:1004 LITTLESTOWN PIKE
Mailing Address - Street 2:SUITE A3
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3007
Mailing Address - Country:US
Mailing Address - Phone:410-751-6858
Mailing Address - Fax:410-751-8999
Practice Address - Street 1:1004 LITTLESTOWN PIKE
Practice Address - Street 2:SUITE A3
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3007
Practice Address - Country:US
Practice Address - Phone:410-751-6858
Practice Address - Fax:410-751-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD152NMedicare ID - Type Unspecified