Provider Demographics
NPI:1710346341
Name:ORTHOLOGY MID-ATLANTIC PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ORTHOLOGY MID-ATLANTIC PHYSICAL THERAPY, INC.
Other - Org Name:ORTHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WISTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-491-4442
Mailing Address - Street 1:11995 SINGETREE LANE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-491-4442
Mailing Address - Fax:888-990-0480
Practice Address - Street 1:2175 K ST NW
Practice Address - Street 2:SUITE C120
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1831
Practice Address - Country:US
Practice Address - Phone:202-463-7611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOLOGY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty