Provider Demographics
NPI:1629476296
Name:SOMERSET PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SOMERSET PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARTOSHESKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-543-9000
Mailing Address - Street 1:949 MOUNT HERMON RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5105
Mailing Address - Country:US
Mailing Address - Phone:410-543-9000
Mailing Address - Fax:410-543-9033
Practice Address - Street 1:12302 SOMERSET AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1312
Practice Address - Country:US
Practice Address - Phone:410-543-9000
Practice Address - Fax:410-543-9033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALISBURY PHYSICAL THERAPY & SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158882251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD071378300Medicaid
MDS4020001OtherCAREFIRST
MD314MMedicare PIN