Mathias Boddicker III

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

25618 Issued in MD

Practice address

14435 Cherry Lane CT
Suite Number 100
Laurel, MD 20707-4959

Phone

(301) 776-3665

NPI assigned

Mar 29, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Maximum Performance Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Laurel, MD
  • NPI 1265809263
  NPD (past) Authorized official

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

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459209600000",
    "number": "1770946758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14435 CHERRY LANE CT",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14435 CHERRY LANE CT",
            "address_2": "SUITE NUMBER 100",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074959",
            "telephone_number": "301-776-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODDICKER",
        "first_name": "MATHIAS",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "25618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Sky Mental Health Clinic LLC
• Melanie A Blythe, NPA
• Angela Boadu, R.D., L.D.N./L.D.
• Awurama Boafo, CCC-SLP
• Boat Transport LLC
• Andrea L Bogger, LCPC
• Oladunni O Bolarinwa
• Cassandre Bolton, LCSW-C, LICSW
• Andrew Alan Bombardier, M.D.
• Carly Bonner, LAT, ATC

• Physical Therapist in Laurel, MD
• Providers in Laurel, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; 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.