Healthcare Provider Details

I. General information

NPI: 1215242490
Provider Name (Legal Business Name): EDUARDO ESCOBEDO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 WOODWORTH ST
SAN FERNANDO CA
91340-4217
US

IV. Provider business mailing address

5215 W CEDAR LN
BETHESDA MD
20814-1548
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26322
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: