Provider Demographics
NPI:1982356671
Name:GBMC-WP-PT
Entity type:Organization
Organization Name:GBMC-WP-PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-842-0115
Mailing Address - Street 1:3411 SWEET AIR RD STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3411 SWEET AIR RD STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21131-1825
Practice Address - Country:US
Practice Address - Phone:410-529-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GBMC-WP-PT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy