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Organization

CHESAPEAKE PHYSICAL AQUATIC THERAPY INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JARED STEWART GOLDSTEIN P.T. (OWNER)
(301) 262-5852
Entity
Organization

Contact information

Practice address
100 WHITE MARSH PARK DR, BOWIE, MD 20715-4361
(301) 262-5852
(301) 262-3173
Mailing address
314 MARSHALL AVE, LAUREL, MD 20707-4823
(301) 262-5852
(301) 262-3173

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2251S0007X
Sports Physical Therapist
2251X0800X
Orthopedic Physical Therapist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
KBX3
BLUE SHIELD MD PROVIDER#
MD
01
S429
BLUE CROSS BLUE SHIELD
DC
Enumeration date
01/22/2007
Last updated
12/19/2008
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