Provider Demographics
NPI:1265428148
Name:HOWARD COUNTY PHYSICAL THERAPY SPORTS REHABILITATION
Entity type:Organization
Organization Name:HOWARD COUNTY PHYSICAL THERAPY SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MULES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-203-0391
Mailing Address - Street 1:6011 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6074
Mailing Address - Country:US
Mailing Address - Phone:410-203-0391
Mailing Address - Fax:410-203-2707
Practice Address - Street 1:6011 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6074
Practice Address - Country:US
Practice Address - Phone:410-203-0391
Practice Address - Fax:410-203-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK666Medicare PIN