Provider Demographics
NPI:1184921736
Name:LEMOINE & ASSOCIATES PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:LEMOINE & ASSOCIATES PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LEMOINE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:410-918-0080
Mailing Address - Street 1:1232 RACE ROAD STE. 203
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:410-918-0080
Mailing Address - Fax:410-918-0050
Practice Address - Street 1:1232 RACE RD STE. 203
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2376
Practice Address - Country:US
Practice Address - Phone:410-918-0080
Practice Address - Fax:410-918-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD552121100Medicaid
MD1184921736OtherGROUP NPI NUMBER
MDDT8446OtherMEDICARE RR NUMBER