Provider Demographics
NPI:1902561855
Name:BALTIMORE PHYSICAL AQUATIC & SPORTS THERAPY LLC
Entity Type:Organization
Organization Name:BALTIMORE PHYSICAL AQUATIC & SPORTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-213-5800
Mailing Address - Street 1:598 CRANBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3702
Mailing Address - Country:US
Mailing Address - Phone:410-213-5808
Mailing Address - Fax:410-213-5810
Practice Address - Street 1:598 CRANBROOK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3702
Practice Address - Country:US
Practice Address - Phone:410-213-5808
Practice Address - Fax:410-213-5810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALTIMORE PHYSICAL, AQUATIC, & SPORTS THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-05
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy