Provider Demographics
NPI:1811229412
Name:CHESAPEAKE BAY AQUATIC & PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:CHESAPEAKE BAY AQUATIC & PHYSICAL THERAPY, INC
Other - Org Name:CHESAPEAKE PHYSICAL & AQUATIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS/PT
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:301-498-2212
Mailing Address - Street 1:PO BOX 4058
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-4058
Mailing Address - Country:US
Mailing Address - Phone:301-262-5852
Mailing Address - Fax:301-262-3173
Practice Address - Street 1:100 WHITE MARSH PARK DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4361
Practice Address - Country:US
Practice Address - Phone:301-262-5852
Practice Address - Fax:301-262-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty