| NPI | 1679630073 |
|---|---|
| Former Legal Business Name | PASADENA GLEN BURNIE PT OFFICES |
| Entity Type | Organization |
| Authorized Contact | TASHEDA BROUGHTON Credentialing Manager 252-248-3313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2024-01-04 |