Provider Demographics
NPI:1942208186
Name:BARRY MICHAELSON PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:BARRY MICHAELSON PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MICHAELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:410-486-0275
Mailing Address - Street 1:1309 PINE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3731
Mailing Address - Country:US
Mailing Address - Phone:410-486-0275
Mailing Address - Fax:410-486-0276
Practice Address - Street 1:1309 PINE RIDGE LN
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3731
Practice Address - Country:US
Practice Address - Phone:410-486-0275
Practice Address - Fax:410-486-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD178222251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD866MMedicare ID - Type UnspecifiedGROUP PRACTICE