MEDICARE: EGAN PHYSICAL THERAPY LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1073281549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EGAN PHYSICAL THERAPY LLC.

Provider Business Mailing Address
First Line	:	4018 GLENRIDGE ST
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-3707
Country	:	US
Telephone Number	:	301-793-6679
Fax Number	:

Provider Business Practice Location Address
First Line	:	7825 TUCKERMAN LN STE 211
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-3241
Country	:	US
Telephone Number	:	301-701-6877
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPHINE EGAN
Credential	:	BSC. (PHYSIO) CMTPT
Telephone Number	:	301-693-3225

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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