Provider Demographics
NPI:1679615793
Name:THE CENTER FOR INTEGRATED MANUAL THERAPIES LLC
Entity Type:Organization
Organization Name:THE CENTER FOR INTEGRATED MANUAL THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMPT
Authorized Official - Phone:410-740-2155
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-0874
Mailing Address - Country:US
Mailing Address - Phone:410-740-2155
Mailing Address - Fax:
Practice Address - Street 1:9159 RED BRANCH RD # F
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2013
Practice Address - Country:US
Practice Address - Phone:410-740-2155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD176NMedicare ID - Type Unspecified