Provider Demographics
NPI:1689399396
Name:NEW FREEDOM PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:NEW FREEDOM PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-652-7230
Mailing Address - Street 1:946 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3628
Mailing Address - Country:US
Mailing Address - Phone:410-652-7230
Mailing Address - Fax:
Practice Address - Street 1:33 ROLLING HILLS RANCH LN
Practice Address - Street 2:
Practice Address - City:PORT DEPOSIT
Practice Address - State:MD
Practice Address - Zip Code:21904-1257
Practice Address - Country:US
Practice Address - Phone:443-267-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy