Basic Information
| Provider Information | |||||||||
| NPI: | 1902124654 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESAPEAKE PHYSICAL AQUATIC THERAPY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21277 | ||||||||
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| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212280777 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5435 BEAVER KILL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107400883 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2010 | ||||||||
| LastUpdateDate: | 05/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | SNYDER | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4107198661 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.