Provider Demographics
NPI:1841569803
Name:CHARLES SCLATER PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CHARLES SCLATER PHYSICAL THERAPY LLC
Other - Org Name:BAYVIEW PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SCLATER
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:443-964-5656
Mailing Address - Street 1:8501 BAYSIDE RD
Mailing Address - Street 2:UNIT C4
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3313
Mailing Address - Country:US
Mailing Address - Phone:443-964-5656
Mailing Address - Fax:443-964-5657
Practice Address - Street 1:8501 BAYSIDE RD
Practice Address - Street 2:UNIT C4
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3350
Practice Address - Country:US
Practice Address - Phone:443-964-5656
Practice Address - Fax:443-964-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty