Provider Demographics
NPI:1679581649
Name:ENHANCED PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:ENHANCED PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TONARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:301-473-9000
Mailing Address - Street 1:198 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-473-9000
Mailing Address - Fax:301-473-9840
Practice Address - Street 1:198 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-473-9000
Practice Address - Fax:301-473-9840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20040225100000X
21531225100000X
MDA2550225200000X
MDA2930225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD496M749FMedicare ID - Type Unspecified