Organization
CHESAPEAKE PHYSICAL AQUATIC THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JARED STEWART GOLDSTEIN P.T. (OWNER)
(410) 315-9080
Entity
Organization
Contact information
Practice address
551F BALTIMORE ANNAPOLIS BLVD, SEVERNA PARK, MD 21146-3809
(410) 315-9080
(410) 315-9012
Mailing address
314 MARSHALL AVE, LAUREL, MD 20707-4823
(410) 315-9080
(410) 315-9012
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KBX3
BLUE SHIELD MD PROVIDER#
MD
01
—
S429
BLUE SHIELD DC PROVIDER#
MD
Enumeration date
01/22/2007
Last updated
12/19/2008
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