24 Truckhouse Road Operations LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

02019 Issued in MD

Legal business name

24 TRUCKHOUSE ROAD OPERATIONS LLC

Doing business as

Severna Park Center

Practice address

310 Genesis Way
Severna Park, MD 21146-1762

Phone

(410) 544-4220

NPI assigned

Apr 21, 2016

Last updated

Sep 7, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael T. Berg

Title

Assistant Secretary

Phone

(505) 468-4752

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Severna Park Center Doing business as

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

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504742400000",
    "number": "1174977540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 GENESIS WAY",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211461762",
            "telephone_number": "410-544-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 GENESIS WAY",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211461762",
            "telephone_number": "410-544-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "24 TRUCKHOUSE ROAD OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-21",
        "last_updated": "2017-09-07",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "02019",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "02019",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "445120100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Severna Park Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Access Health Services

• Physical Therapist in Severna Park, MD
• Providers in Severna Park, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2017; 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.