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Organization
KINESIO PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC
Active
Organization
KINESIO PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH K HAGERTY P.T. (MANAGING MEMBER)
(410) 987-5746
Entity
Organization
Contact information
Practice address
821 W BENFIELD RD, SUITE 7, SEVERNA PARK, MD 21146-2220
(443) 994-2640
Mailing address
418 RED BIRCH RD, MILLERSVILLE, MD 21108-1414
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17817
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578634077
MEDICARE NPI INDIVIDUAL
—
01
—
320171
MEDICARE IDENTIFICATION NUMBER
—
Enumeration date
01/21/2014
Last updated
01/21/2014
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