Organization
24 TRUCKHOUSE ROAD OPERATIONS LLC
Active
Other names
Severna Park Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
310 GENESIS WAY, SEVERNA PARK, MD 21146-1762
(410) 544-4220
Mailing address
310 GENESIS WAY, SEVERNA PARK, MD 21146-1762
(410) 544-4220
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02019
MD
225X00000X
Occupational Therapist
02019
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
445120100
—
MD
Enumeration date
04/21/2016
Last updated
09/07/2017
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