| NPI | 1225035736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK ANTONIO BRIDDELL Owner/Physical Therapist 410-251-4467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NC 11098) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: SC 5297) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: MD 17958) | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: DE J1-0001697) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2007-08-17 |