NPIMap

Organization Active NPI

Mind Body Physical Therapy & Wellness Center, Inc.

  • Specialist
  • Baltimore, MD
National Provider Identifier
1164437828
Registry record updated Nov 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MIND BODY PHYSICAL THERAPY & WELLNESS CENTER, INC.
Practice address
1400 Coppermine Ter
Terrace
Baltimore, MD 21209-2012
Phone
(443) 279-1777
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2016

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

Authorized official

Name
Wendy A Quitasol, PTNPI 1841228855
Title
Owner/Office Manager
Phone
(443) 279-1777

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1400 Coppermine Ter
Terrace
Baltimore, MD 21209-2012

Mailing address

1400 Coppermine Ter
Baltimore, MD 21209-2012
Phone (443) 279-1777

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060822000602 MD Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2567465099 Receives reassigned benefits from 8 practitioners
Practice locations: Baltimore, MD

National Provider Directory

National Provider Directory

Locations

1400 Coppermine Ter
Ste 101
Baltimore, MD 21209

1400 Coppermine Ter
Baltimore, MD 21209
Phone (443) 279-1777

Practitioners & affiliated clinicians

Practitioners 8

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": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480291200000",
    "number": "1164437828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 COPPERMINE TER",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092012",
            "telephone_number": "443-279-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 COPPERMINE TER",
            "address_2": "TERRACE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092012",
            "telephone_number": "443-279-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY PHYSICAL THERAPY & WELLNESS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2016-11-28",
        "status": "A",
        "authorized_official_last_name": "QUITASOL",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/OFFICE MANAGER",
        "authorized_official_telephone_number": "443-279-1777",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; 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.