Healthcare Provider Details

I. General information

NPI: 1568568038
Provider Name (Legal Business Name): ELIZABETH ELLIOTT O'DONOGHUE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5232 44TH ST NW
WASHINGTON DC
20015-2100
US

IV. Provider business mailing address

109 LEXINGTON DR
SILVER SPRING MD
20901-2546
US

V. Phone/Fax

Practice location:
  • Phone: 240-400-5838
  • Fax:
Mailing address:
  • Phone: 202-486-4334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number18099
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2918
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number18099
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: