Provider Demographics
NPI:1609315126
Name:CPT, LLC
Entity Type:Organization
Organization Name:CPT, LLC
Other - Org Name:POTOMAC BEHAVIORAL AND OCCUPATIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-722-0616
Mailing Address - Street 1:249 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1638
Mailing Address - Country:US
Mailing Address - Phone:240-362-7444
Mailing Address - Fax:240-362-7388
Practice Address - Street 1:249 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1638
Practice Address - Country:US
Practice Address - Phone:240-362-7444
Practice Address - Fax:240-362-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD422303Medicare PIN