Organization
CHESAPEAKE PHYSICAL AQUATIC THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JARED STEWART GOLDSTEIN MPT (OWNER/PT)
(410) 381-7000
Entity
Organization
Contact information
Practice address
7080 DEEPAGE DR., COLUMBIA, MD 21045
(410) 381-7000
(410) 381-3779
Mailing address
7080 DEEPAGE DR., COLUMBIA, MD 21045
(410) 381-7000
(410) 381-3779
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KBX3
BLUE SHIELD MD
MD
01
—
S429
BLUE SHIELD DC
MD
Enumeration date
01/22/2007
Last updated
07/02/2013
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