Tory Custis Widdowson IV
Individual provider Active NPI Physical Therapist · Crisfield, MD
NPI 1003083874 · NPPES record last updated May 12, 2008
Key facts
- NPI
- 1003083874
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 15792 (MD)
- Practice address
- 201 Hall Highway
McCready Foundation Inc
Crisfield, MD 21817-1237 - Phone
- (410) 968-1200
- Fax
- (410) 968-3178
- NPI assigned
- May 12, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Interoperability endpoints
- https://eweb.tidalhealth.org/Oauth2/api/FHIR/R4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 15792 | MD | Yes |
Addresses
Primary practice location
201 Hall Highway
McCready Foundation Inc
Crisfield, MD 21817-1237
Mailing address
201 Hall Highway
McCready Foundation Inc
Crisfield, MD 21817-1237
Phone (410) 968-1200
Other providers in Crisfield, MD
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Primary Care, LLC
- Gunta A Wheeler
- Shah Mohammed Yahya
All providers in Crisfield, MD · Physical Therapist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.