Provider Demographics
NPI:1689863037
Name:ENCOMPASS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ENCOMPASS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANHEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:410-266-1500
Mailing Address - Street 1:130 ADMIRAL COCHRANE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7368
Mailing Address - Country:US
Mailing Address - Phone:410-266-1500
Mailing Address - Fax:410-266-1369
Practice Address - Street 1:130 ADMIRAL COCHRANE DR STE 101
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7368
Practice Address - Country:US
Practice Address - Phone:410-266-1500
Practice Address - Fax:410-266-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407999000Medicaid
MD865MMedicare PIN