NPIMap

Organization Active NPI

Tidewater Physical Therapy and Rehabilitation Associates, P.a.

  • Physical Therapist
  • Easton, MD
National Provider Identifier
1730263302
Registry record updated Aug 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
TIDEWATER PHYSICAL THERAPY AND REHABILITATION ASSOCIATES, P.A.
Practice address
406 Marvel CT
Easton, MD 21601-4052
Phone
(410) 822-4613
Fax
(410) 822-6534
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2012

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

Authorized official

Name
Linda Booze
Title
Finance Manager
Phone
(410) 822-4613

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

406 Marvel CT
Easton, MD 21601-4052

Mailing address

PO Box 1564
Easton, MD 21601-8932
Phone (410) 822-4613

Other identifiers 2

IdentifierTypeStateIssuer
0000220726MedicaidDE
435138000MedicaidMD

Other names 1

  • Tidewater Physical Therapy Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040128000258 MD Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 9032012166 Practice locations: Cambridge, MD; St Michaels, MD; Salisbury, MD; Ocean Pines, MD; Denton, MD; Chester, MD; Centreville, MD; Easton, MD
O20040413000916 DE Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 9032012166 Practice locations: Harrington, DE; Lewes, DE; Milton, DE; Ocean View, DE; Seaford, DE

Outpatient physical therapy / speech pathology certification: CCN 216538

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
TIDEWATER PHYSICAL THERAPY
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Mar 28, 1985
Last certification
Sep 28, 2023
Ownership / control type
Proprietary
Facility address
406 Marvel Court
Easton, MD 21601

National Provider Directory

National Provider Directory

Locations

612 Mulberry St
Milton, DE 19968
Phone (302) 684-2829

622 Sunburst Hwy
Cambridge, MD 21613
Phone (410) 228-0742

140 Pennsylvania Ave
Ste 1A
Centreville, MD 21617
Phone (410) 758-3816

416 N 6th St
Denton, MD 21629
Phone (410) 479-3059

412 N 6th St
Denton, MD 21629
Phone (410) 479-3059

11312 Manklin Creek Rd
Ocean Pines, MD 21811
Phone (410) 208-3440

11312 Manklin Creek Rd
Unit 3
Ocean Pines, MD 21811
Phone (410) 208-3440

101C Market St
Pocomoke City, MD 21851
Phone (410) 957-4050

1344 S Division St
Salisbury, MD 21804

1013 S Talbot St
Ste 10
St Michaels, MD 21663
Phone (410) 745-3701

1013 S Talbot St
#46
St Michaels, MD 21663
Phone (410) 745-3701

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344902400000",
    "number": "1730263302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1564",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216018932",
            "telephone_number": "410-822-4613",
            "fax_number": "410-822-6534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 MARVEL CT",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216014052",
            "telephone_number": "410-822-4613",
            "fax_number": "410-822-6534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER PHYSICAL THERAPY AND REHABILITATION ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2012-08-14",
        "status": "A",
        "authorized_official_last_name": "BOOZE",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "FINANCE MANAGER",
        "authorized_official_telephone_number": "410-822-4613"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000220726",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "435138000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidewater Physical Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Easton, MD

Sources for this page

Verify at the official NPI Registry.