Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 18707 | MD |
N | 2251G0304X | Physical Therapist - Geriatrics | 18707 | MD |
N | 2251H1200X | Hand | 18707 | MD |
N | 2251S0007X | Physical Therapist - Sports | 18707 | MD |
N | 2251X0800X | Physical Therapist - Orthopedic | 18707 | MD |
NPI | 1073743829 |
---|---|
Provider Name | Mr. Richard Harland Baskins JR. |
First Address | Crofton, MD 21114-0330 |
Second Address | Largo, MD 20774-3705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 15/07/2009 |