# 35 MILKSHAKE LANE OPERATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Spa Creek Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043664493
- **Authorized official:** MICHAEL T. BERG (ASSISTANT SECRETARY)
- **Authorized official phone:** (505) 468-4752

## Contact information

- **Practice address:** 35 MILKSHAKE LN, ANNAPOLIS, MD 21403-1507
- **Practice address phone:** (410) 269-5100
- **Mailing address:** 35 MILKSHAKE LN, ANNAPOLIS, MD 21403-1507
- **Mailing address phone:** (410) 269-5100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 02026 | MD | Yes |
| 225X00000X | Occupational Therapist | 02026 | MD | — |

## Other

- **Enumeration date:** 04/21/2016
- **Last updated:** 09/07/2017