Provider Demographics
NPI:1215154653
Name:DUNDALK VILLAGE THERAPY, INC.
Entity type:Organization
Organization Name:DUNDALK VILLAGE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DESALES
Authorized Official - Last Name:SCHROEN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA,
Authorized Official - Phone:410-282-9331
Mailing Address - Street 1:2 DUNMANWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-5144
Mailing Address - Country:US
Mailing Address - Phone:410-282-9331
Mailing Address - Fax:410-282-9332
Practice Address - Street 1:2 DUNMANWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-5144
Practice Address - Country:US
Practice Address - Phone:410-282-9331
Practice Address - Fax:410-282-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR058 0001OtherBLUE CHOICE
MDLM06OtherCAREFIRST BLUE CROSS
MD806700700Medicaid
MD967MMedicare ID - Type UnspecifiedGROUP #