Organization
CHESAPEAKE PHYSICAL AQUATIC THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JARED S GOLDSTEIN PT (OWNER)
(410) 381-7000
Entity
Organization
Contact information
Practice address
7080 DEEPAGE DR, COLUMBIA, MD 21045-5219
(410) 381-7000
(410) 381-3779
Mailing address
314 MARSHALL AVE, LAUREL, MD 20707-4823
(301) 498-2212
(301) 498-2213
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
19690
MD
2251S0007X
Sports Physical Therapist
19690
MD
2251X0800X
Orthopedic Physical Therapist
19690
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KBX3
BLUE CROSS BLUE SHIELD
MD
01
—
S429
BLUE CROSS BLUE SHIELD
MD
Enumeration date
12/12/2006
Last updated
12/19/2008
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