Provider Demographics
NPI:1255379780
Name:RECEK, KRISTY (MPT)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:RECEK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 BARRYMORE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-6973
Mailing Address - Country:US
Mailing Address - Phone:410-663-6450
Mailing Address - Fax:410-663-6451
Practice Address - Street 1:7672 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4088
Practice Address - Country:US
Practice Address - Phone:410-663-6450
Practice Address - Fax:410-663-6451
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4846270001OtherDME POS
MD522248150OtherIHP, COVENTRY, UNITED HC
MD2144336OtherOPTIMUM CHOICE
MDPENDINGMedicaid
MD350342400OtherOWCP
MD51647OtherTRICARE, EHP, PRIORITY PA
MDPENDINGOtherBCBS
MD2144336OtherALLIANCE
MD2144336OtherOPTIMUM CHOICE
MDPENDINGMedicaid