Organization
CHESAPEAKE PHYSICAL & AQUATIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JARED STEWART GOLDSTEIN P.T. (OWNER)
(410) 381-7000
Entity
Organization
Contact information
Practice address
13946 BALTIMORE AVE, LAUREL, MD 20707-5000
(301) 498-2212
(301) 498-2213
Mailing address
13946 BALTIMORE AVE., LAUREL, MD 20707
(301) 498-2212
(301) 498-2213
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KBX3
BLUE CROSS MD PROVIDER #
MD
01
—
S429
BLUE CROSS DC PROVIDER #
MD
Enumeration date
01/23/2007
Last updated
08/22/2020
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