Individual provider Active NPI

Kevin Dolan, PT, DPT

  • Physical Therapist
  • Gaithersburg, MD
National Provider Identifier
1023693009
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
28359 Issued in MD
Practice address
828 Muddy Branch Rd # 14
Gaithersburg, MD 20878-2780
Phone
(301) 685-1311
NPI assigned
Mar 11, 2021
Last updated
Mar 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 28359 MD Primary

Addresses

Primary practice location

828 Muddy Branch Rd # 14
Gaithersburg, MD 20878-2780

Mailing address

1720 Meridian Dr
Hagerstown, MD 21742-1235
Phone (301) 401-6947

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210324002208 MD Practitioner - Physical Therapist in Private Practice 2264849942 Reassigns benefits to 1 organization
I20210324002507 DC Practitioner - Physical Therapist in Private Practice 2264849942 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Maryland Sportscare and Rehab LLCGroup PAC ID 2860440427, 166 clinicians

Practice addresses (Care Compare)

828 Muddy Branch Rd
Suite 14
Gaithersburg, MD 20878-2780
Phone (301) 685-1311

9815 Main St
Suite 206
Damascus, MD 20872-2099
Phone (301) 253-6761

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Sportscare & Rehab, LLC Physical Therapist CurrentSince Sep 16, 2021 Accepting new patients
Maryland Sportscare & Rehab LLC Physical Therapist CurrentSince Mar 22, 2021 Accepting new patients
Maryland Sportscare & Rehab, LLC Physical Therapist CurrentSince Mar 22, 2021 Accepting new patients

Locations

9815 Main St
Ste 206
Damascus, MD 20872
Phone (301) 253-6761

141 Thomas Johnson Dr
Ste 180
Frederick, MD 21702
Phone (301) 620-7478

828 Muddy Branch Rd
#14
Gaithersburg, MD 20878
Phone (301) 685-1311

25 Main St
Ste A
Reisterstown, MD 21136
Phone (410) 833-8300

1600 Wilson Blvd
Ste 102
Arlington, VA 22209
Phone (301) 464-4500

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1023693009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 MERIDIAN DR",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217421235",
            "telephone_number": "301-401-6947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 MUDDY BRANCH RD # 14",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208782780",
            "telephone_number": "301-685-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLAN",
        "first_name": "KEVIN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-11",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "28359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.