NPIMap

Organization Active NPI

Bayside Physical Therpay and Sports Rehabilitation, Inc

  • Occupational Therapist
  • Edgewater, MD
National Provider Identifier
1114096880
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
BAYSIDE PHYSICAL THERPAY AND SPORTS REHABILITATION, INC
Practice address
3179 Braverton St
Suite 201
Edgewater, MD 21037-2665
Phone
(410) 956-4308
NPI assigned
Nov 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Kevin C. Wrenn, D.P.T.NPI 1043381981
Title
Vice President
Phone
(410) 956-4308

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 TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

3179 Braverton St
Suite 201
Edgewater, MD 21037-2665

Mailing address

3179 Braverton St
Suite 201
Edgewater, MD 21037-2665
Phone (410) 956-4308

National Provider Directory

National Provider Directory
Tax ID family
Bayside Physical Therapy and Rehabilitation Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

4201 Mitchellville Rd
Ste 102
Bowie, MD 20716
Phone (301) 262-5900

202 Coursevall Dr
Ste 111
Centreville, MD 21617
Phone (410) 758-0018

3179 Braverton St
Ste 201
Edgewater, MD 21037
Phone (410) 956-4308

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1114096880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3179 BRAVERTON ST",
            "address_2": "SUITE 201",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372665",
            "telephone_number": "410-956-4308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3179 BRAVERTON ST",
            "address_2": "SUITE 201",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372665",
            "telephone_number": "410-956-4308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSIDE PHYSICAL THERPAY AND SPORTS REHABILITATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "WRENN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "410-956-4308",
        "authorized_official_credential": "D.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewater, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.