610 Dutchmans Lane Operations LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

20002 Issued in MD

Legal business name

610 DUTCHMANS LANE OPERATIONS LLC

Doing business as

The Pines

Practice address

610 Dutchmans LN
Easton, MD 21601-3346

Phone

(410) 822-4000

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

• The Pines 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": "1346694718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 DUTCHMANS LN",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216013346",
            "telephone_number": "410-822-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 DUTCHMANS LN",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216013346",
            "telephone_number": "410-822-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "610 DUTCHMANS LANE 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": "20002",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "20002",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "552405900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pines",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapist in Easton, MD
• Providers in Easton, 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.