Provider Demographics
NPI:1558508457
Name:PT MEDICAL, LLC
Entity type:Organization
Organization Name:PT MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-922-1092
Mailing Address - Street 1:1805 DERRS CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-2519
Mailing Address - Country:US
Mailing Address - Phone:301-668-7041
Mailing Address - Fax:301-698-5644
Practice Address - Street 1:1805 DERRS CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-2519
Practice Address - Country:US
Practice Address - Phone:301-668-7041
Practice Address - Fax:301-698-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies