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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