Provider Demographics
NPI:1689124729
Name:LHMG PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:LHMG PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ODENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-481-6415
Mailing Address - Street 1:1106 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1637
Mailing Address - Country:US
Mailing Address - Phone:410-674-1650
Mailing Address - Fax:410-674-1651
Practice Address - Street 1:1106 ANNAPOLIS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1637
Practice Address - Country:US
Practice Address - Phone:410-674-1650
Practice Address - Fax:410-674-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD455625ZR1SMedicare PIN