# KINESIO PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073936407
- **Authorized official:** FAITH K HAGERTY P.T. (MANAGING MEMBER)
- **Authorized official phone:** (410) 987-5746

## Contact information

- **Practice address:** 821 W BENFIELD RD, SUITE 7, SEVERNA PARK, MD 21146-2220
- **Practice address phone:** (443) 994-2640
- **Mailing address:** 418 RED BIRCH RD, MILLERSVILLE, MD 21108-1414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 17817 | MD | Yes |

## Other

- **Enumeration date:** 01/21/2014
- **Last updated:** 01/21/2014