Provider Demographics
NPI:1902396005
Name:PHYSICA MEDICA LLC
Entity Type:Organization
Organization Name:PHYSICA MEDICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:MAKSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:443-831-0883
Mailing Address - Street 1:6803 HARROWDALE RD APT 202
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4943
Mailing Address - Country:US
Mailing Address - Phone:443-831-0883
Mailing Address - Fax:
Practice Address - Street 1:800 S BOND ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3708
Practice Address - Country:US
Practice Address - Phone:443-831-0883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25385225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty