NPIMap

Organization Active NPI

Chesapeake Bay Aquatic & Physical Therapy Inc.

  • Physical Therapist
  • Timonium, MD
National Provider Identifier
1073859476
Registry record updated Nov 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CHESAPEAKE BAY AQUATIC & PHYSICAL THERAPY INC.
Practice address
9475 Deereco Rd Ste 102
Timonium, MD 21093-2124
Phone
(410) 308-3543
Fax
(410) 308-4661
NPI assigned
Dec 13, 2012
Last updated
Nov 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2020

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

Authorized official

Name
Danielle Goldstein, DPTNPI 1275688806
Title
Director of Operations
Phone
(301) 498-2212

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X

Addresses

Primary practice location

9475 Deereco Rd Ste 102
Timonium, MD 21093-2124

Mailing address

PO Box 4058
Crofton, MD 21114-4058
Phone (301) 262-5852

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100601000042 MD Part B Supplier - Clinic/Group Practice 0749319788 Receives reassigned benefits from 10 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Reistertown, MD; Timonium, MD

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Chesapeake Bay Aquatic Physical Therapy Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2430 Broad Ave
Timonium, MD 21093
Phone (410) 308-3543

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605139200000",
    "number": "1073859476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4058",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211144058",
            "telephone_number": "301-262-5852",
            "fax_number": "301-262-3173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9475 DEERECO RD STE 102",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210932124",
            "telephone_number": "410-308-3543",
            "fax_number": "410-308-4661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESAPEAKE BAY AQUATIC & PHYSICAL THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-13",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A",
        "authorized_official_last_name": "GOLDSTEIN",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "301-498-2212",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Timonium, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.