NPIMap

Organization Active NPI

Chesapeake Physical Aquatic Therapy Inc

  • Physical Therapist
  • Severna Park, MD
National Provider Identifier
1124172895
Registry record updated Dec 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CHESAPEAKE PHYSICAL AQUATIC THERAPY INC
Practice address
551F Baltimore Annapolis Blvd
Severna Park, MD 21146-3809
Phone
(410) 315-9080
Fax
(410) 315-9012
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2008

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

Authorized official

Name
Mr. Jared Stewart Goldstein, P.T.
Title
Owner
Phone
(410) 315-9080

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary
Orthopedic Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251X0800X

Addresses

Primary practice location

551F Baltimore Annapolis Blvd
Severna Park, MD 21146-3809

Mailing address

314 Marshall Ave
Laurel, MD 20707-4823
Phone (410) 315-9080

Other identifiers 2

IdentifierTypeStateIssuer
KBX3OtherMDBLUE SHIELD MD PROVIDER#
S429OtherMDBLUE SHIELD DC PROVIDER#

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229644800000",
    "number": "1124172895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 MARSHALL AVE",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074823",
            "telephone_number": "410-315-9080",
            "fax_number": "410-315-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551F BALTIMORE ANNAPOLIS BLVD",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211463809",
            "telephone_number": "410-315-9080",
            "fax_number": "410-315-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESAPEAKE PHYSICAL AQUATIC THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2008-12-19",
        "status": "A",
        "authorized_official_last_name": "GOLDSTEIN",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "STEWART",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-315-9080",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD MD PROVIDER#",
            "identifier": "KBX3",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD DC PROVIDER#",
            "identifier": "S429",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Severna Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2008; 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.