Provider Demographics
NPI:1598226821
Name:PENINSULA PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:PENINSULA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FILART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-831-3817
Mailing Address - Street 1:720 E COLLEGE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6651
Mailing Address - Country:US
Mailing Address - Phone:410-603-9237
Mailing Address - Fax:
Practice Address - Street 1:701 E NAYLOR MILL RD UNIT F
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2308
Practice Address - Country:US
Practice Address - Phone:410-831-3817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENINSULA PHYSICAL THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty