Provider Demographics
NPI:1396880100
Name:POOLESVILLE PHYSICAL THERAPY
Entity type:Organization
Organization Name:POOLESVILLE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:KAPSIAK
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-349-5443
Mailing Address - Street 1:19628 FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2065
Mailing Address - Country:US
Mailing Address - Phone:301-349-5443
Mailing Address - Fax:301-349-2074
Practice Address - Street 1:19628 FISHER AVE
Practice Address - Street 2:
Practice Address - City:POOLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20837-2065
Practice Address - Country:US
Practice Address - Phone:301-349-5443
Practice Address - Fax:301-349-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15401OtherSTATE LICENSE
MD15401OtherSTATE LICENSE