Individual provider Active NPI

Anne Coakley, PT

  • Orthopedic Physical Therapist
  • Ellicott City, MD
National Provider Identifier
1720074511
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
16463 Issued in MD
Practice address
6011 University Blvd
Suite 120
Ellicott City, MD 21043-6074
Phone
(410) 203-0391
Fax
(410) 203-2707
NPI assigned
Sep 27, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physical Therapist 2251S0007X 16463 MD
Orthopedic Physical Therapist 2251X0800X 16463 MD Primary

Addresses

Primary practice location

6011 University Blvd
Suite 120
Ellicott City, MD 21043-6074

Mailing address

3901 National Dr
Ste 100
Burtonsville, MD 20866-1176
Phone (301) 421-1125

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051006000104 MD Practitioner - Physical Therapist in Private Practice 8123043452 Reassigns benefits to 2 organizations
I20220210002958 DC Practitioner - Physical Therapist in Private Practice 8123043452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forever Fit Physical Therapy and Wellness LLCGroup PAC ID 1153513122, 40 clinicians

Practice addresses (Care Compare)

3901 National Dr
Suite 100
Burtonsville, MD 20866-1176
Phone (301) 421-1125

7130 Minstrel Way
Ll110
Columbia, MD 21045-5261
Phone (240) 841-2639

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16463MDMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Forever Fit Physical Therapy & Wellness, LLC CurrentSince Dec 16, 2019 Accepting new patients
Forever Fit Physical Therapy & Wellness CurrentSince Dec 16, 2019 Accepting new patients
Forever Fit Physical Therapy & Wellness LLC CurrentSince Nov 3, 2021 Accepting new patients
Howard County Physical Therapy Sports Rehabilitation CurrentSince Oct 14, 1991 Accepting new patients

Locations

3901 National Dr
Ste 100
Burtonsville, MD 20866
Phone (301) 232-3684

7130 Minstrel Way
Ste LL110
Columbia, MD 21045
Phone (240) 841-2639

6011 University Blvd
Ste 120
Ellicott City, MD 21043
Phone (410) 203-0391

4801 Dorsey Hall Dr
Ste 130
Ellicott City, MD 21042
Phone (410) 730-9851

10301 Georgia Ave
Ste 200
Silver Spring, MD 20902
Phone (301) 593-7300

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1720074511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 NATIONAL DR",
            "address_2": "STE 100",
            "city": "BURTONSVILLE",
            "state": "MD",
            "postal_code": "208661176",
            "telephone_number": "301-421-1125",
            "fax_number": "301-500-2175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6011 UNIVERSITY BLVD",
            "address_2": "SUITE 120",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436074",
            "telephone_number": "410-203-0391",
            "fax_number": "410-203-2707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COAKLEY",
        "first_name": "ANNE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-27",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "MD",
            "license": "16463",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MD",
            "license": "16463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.