Provider Demographics
NPI:1336244888
Name:ANNAPOLIS FAMILY PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:ANNAPOLIS FAMILY PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN DOUGLASS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLOP
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-266-6626
Mailing Address - Street 1:105 INDIAN SPRING CT
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-3213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2564 RIVA RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7405
Practice Address - Country:US
Practice Address - Phone:410-266-6626
Practice Address - Fax:410-266-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherTAX ID