Provider Demographics
NPI:1548290224
Name:AMBER HILL PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:AMBER HILL PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-663-1157
Mailing Address - Street 1:187 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4503
Mailing Address - Country:US
Mailing Address - Phone:301-663-1157
Mailing Address - Fax:301-663-1229
Practice Address - Street 1:187 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 6
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4503
Practice Address - Country:US
Practice Address - Phone:301-663-1157
Practice Address - Fax:301-663-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH258Medicare ID - Type UnspecifiedMEDICARE NUMBER
DCG01358Medicare PIN