# BLUE WATER PHYSIATRY L L C

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BLUE WATER PHYSIATRY L L C
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1770764490
- **Legal business name:** BLUE WATER PHYSIATRY L L C
- **Authorized official:** ARTHUR PETER BARLETTA MD (PRESIDENT)
- **Authorized official phone:** (301) 877-6110

## Contact information

- **Practice address:** 7501 SURRATTS ROAD, \#202, CLINTON, MD 20735-2256
- **Practice address phone:** (301) 877-6110
- **Practice address fax:** (301) 877-2695
- **Mailing address:** 6368 COVENTRY WAY, \#365, CLINTON, MD 20735-2256
- **Mailing address phone:** (301) 877-6110
- **Mailing address fax:** (301) 877-2695

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | D0039416 | MD | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | D0039416 | MD | — |

## Other

- **Enumeration date:** 11/21/2007
- **Last updated:** 02/14/2012