Organization
PHYSIOTHERAPY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM RICE (HR)
(610) 644-7824
Entity
Organization
Contact information
Practice address
4924 CAMPBELL BLVD, SUITE 130A, NOTTINGHAM, MD 21236-5908
(610) 884-4814
Mailing address
4924 CAMPBELL BLVD, SUITE 130A, NOTTINGHAM, MD 21236-5908
(610) 884-4814
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
21190
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11779850
CAQH
—
01
—
1245244938
CHAMPUST
—
01
—
216512
MEDICARE ID
MD
01
—
3503195000
IBC AMERIHEALTH
—
01
—
50700047
CAREFIRST
—
01
—
88760514
NCA
—
Enumeration date
08/26/2014
Last updated
08/26/2014
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