Provider Demographics
NPI:1558559021
Name:ARUNDEL PHYSICAL THERAPY & FITNESS, LLC
Entity Type:Organization
Organization Name:ARUNDEL PHYSICAL THERAPY & FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:410-916-3689
Mailing Address - Street 1:1418 SAYBROOKE CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-5936
Mailing Address - Country:US
Mailing Address - Phone:410-916-3689
Mailing Address - Fax:
Practice Address - Street 1:1418 SAYBROOKE CT
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-5936
Practice Address - Country:US
Practice Address - Phone:410-916-3689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty