Provider Demographics
NPI:1679202972
Name:FELICE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FELICE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEROD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FELICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-408-8341
Mailing Address - Street 1:11270 PEPPER RD
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1202
Mailing Address - Country:US
Mailing Address - Phone:814-502-6532
Mailing Address - Fax:443-320-4125
Practice Address - Street 1:551 BALTIMORE ANNAPOLIS BLVD STE D
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3809
Practice Address - Country:US
Practice Address - Phone:443-441-0676
Practice Address - Fax:443-320-4125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FELICE PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy