NPIMap

Organization Active NPI

Perform for Life Physical Therapy

  • Physical Therapy Clinic/Center
  • Severna Park, MD
National Provider Identifier
1417427345
Registry record updated May 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PERFORM FOR LIFE PHYSICAL THERAPY
Practice address
537 Baltimore Annapolis Blvd Ste D
Severna Park, MD 21146-3812
Phone
(410) 544-8444
NPI assigned
Dec 4, 2018
Last updated
May 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2020

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

Authorized official

Name
Ashley M SimmonsNPI 1518214105
Title
Owner
Phone
(410) 991-6978

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
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

537 Baltimore Annapolis Blvd Ste D
Severna Park, MD 21146-3812

Mailing address

537 Baltimore Annapolis Blvd Ste D
Severna Park, MD 21146-3812
Phone (410) 544-8444

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190110000547 MD Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5597001669 Receives reassigned benefits from 2 practitioners
Practice locations: Severna Park, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1543881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1417427345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "537 BALTIMORE ANNAPOLIS BLVD STE D",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211463812",
            "telephone_number": "410-544-8444",
            "fax_number": "410-544-7941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "537 BALTIMORE ANNAPOLIS BLVD STE D",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211463812",
            "telephone_number": "410-544-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORM FOR LIFE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-04",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-991-6978"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 May 21, 2020; 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.