Provider Demographics
NPI:1811032865
Name:HOME PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:HOME PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-531-7558
Mailing Address - Street 1:3130 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1024
Mailing Address - Country:US
Mailing Address - Phone:410-531-7558
Mailing Address - Fax:410-531-7558
Practice Address - Street 1:3130 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1024
Practice Address - Country:US
Practice Address - Phone:410-531-7558
Practice Address - Fax:410-531-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16690225100000X
MD15420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKAF3OtherBCBS
MD743MMedicare ID - Type Unspecified