35 Milkshake Lane Operations Llc - Physical Therapist in Annapolis, Maryland | ProviderWire

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Physical Therapist
Maryland
Annapolis
35 Milkshake Lane Operations Llc

Legal Business Name

35 Milkshake Lane Operations Llc

Also Known As

Spa Creek Center

NPI Number

1043664493

NPI Type

Organization

Enumeration Date

04/21/2016

Specialties

(Taxonomies)

Name

Physical Therapist

Occupational Therapist

Code

225100000X

225X00000X

Primary Taxonomy

Yes

No

Licenses

State

Maryland

License Number

02026

Contact
Information

Purpose

Mailing

Location

Address

35 MILKSHAKE LN

35 MILKSHAKE LN

City

Annapolis

Annapolis

State

MD

MD

Postal Code

21403-1507

21403-1507

Country

US

US

Telephone Number

(410) 269-5100

(410) 269-5100

Authorized Official

Name

Michael Berg

Title or Position

ASSISTANT SECRETARY

Telephone Number

(505) 468-4752

Identifiers

Identifier

446610100

Identifier State

MD

Identifier Issuer

Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 09/07/2017

Provider Address

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