Provider Demographics
NPI:1487805685
Name:HAILE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:HAILE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAILE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-571-1151
Mailing Address - Street 1:116 AMESBURY CT
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1200
Mailing Address - Country:US
Mailing Address - Phone:410-647-7326
Mailing Address - Fax:
Practice Address - Street 1:2152 RENARD CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-6756
Practice Address - Country:US
Practice Address - Phone:410-571-1151
Practice Address - Fax:410-266-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MD16024261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1053539601OtherINDIVIDUAL NPI