Peninsula Rehab & Sports Medicine, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

23989297 Issued in MD

Legal business name

PENINSULA REHAB & SPORTS MEDICINE, INC.

Practice address

12913 Coastal Hwy
Ocean City, MD 21842-4718

Phone

(410) 213-7878

Fax

(410) 213-7879

NPI assigned

Jul 29, 2015

Organization subpart

Yes

Parent organization

PENINSULA REHAB & SPORTS MEDICINEAs reported in NPPES

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

Authorized official

Name

Mr. Ronald Marc Wist, P.T.

Title

Owner/President

Phone

(410) 213-7878

Specialties & licenses 1

Addresses

Tax ID family

Peninsula Rehabilitation Sports Medicine Inc2 organizations share this tax ID, including this one

Part of

Peninsula Rehabilitation Sports Medicine Inc

Other organizations with this tax ID 1

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

• Peninsula Rehabilitation and Sports Medicine, Inc.

  • Physical Therapist
  • Rehoboth Beach, DE
  • NPI 1417115049
  NPD tax ID

Locations

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

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438128000000",
    "number": "1376928556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12417 OCEAN GTWY",
            "address_2": "#9",
            "city": "OCEAN CITY",
            "state": "MD",
            "postal_code": "218429521",
            "telephone_number": "410-213-7878",
            "fax_number": "410-213-7879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12913 COASTAL HWY",
            "city": "OCEAN CITY",
            "state": "MD",
            "postal_code": "218424718",
            "telephone_number": "410-213-7878",
            "fax_number": "410-213-7879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA REHAB & SPORTS MEDICINE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENINSULA REHAB & SPORTS MEDICINE",
        "enumeration_date": "2015-07-29",
        "last_updated": "2015-07-29",
        "status": "A",
        "authorized_official_last_name": "WIST",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "MARC",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "410-213-7878",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "23989297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ocean City Family Practice &Urgent Care, P.C.
• Ocean City Primary Care
• Ocean Wellness
• Caleb Wesley Page Jr., MD
• Peninsula Pain Management, LLC
• Peninsula Rehabilitation & Sports Medicine, Inc.
• Thomas T Penroach, M.D.
• Lisa Ann Peppers, PSY.D.
• Maia Perone, CNS
• Gina Petruzzo

• Physical Therapist in Ocean City, MD
• Providers in Ocean City, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; 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.