Individual
MR. IAN WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
1630 MAIN ST STE 110, CHESTER, MD 21619-2792
(410) 643-3410
(410) 643-3461
Mailing address
1630 MAIN ST STE 110, CHESTER, MD 21619-2792
(410) 643-3410
(410) 643-3461
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
20621
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102255320
ACS/DOL PROVIDER #
MD
01
—
290981
MAMSI PROVIDER NUMBER
MD
01
—
4761-0175
CAREFIRST BLUE CHOICE
MD
01
—
616428
BCBS OF MD PROVIDER #
MD
01
—
61671003
CAREFIRST BCBS PROVIDER #
MD
01
—
PT20621
PT LICENSE NUMBER
MD
Enumeration date
07/27/2006
Last updated
11/17/2022
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