Healthcare Provider Details

I. General information

NPI: 1255489092
Provider Name (Legal Business Name): PHYSICAL AND MASSAGE THERAPY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ALBEMARLE ST NW #501
WASHINGTON DC
20016
US

IV. Provider business mailing address

4000 ALBEMARLE ST NW #501
WASHINGTON DC
20016
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-2033
  • Fax: 202-966-2034
Mailing address:
  • Phone: 202-966-2033
  • Fax: 202-966-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberL14860
License Number StateDC

VIII. Authorized Official

Name: CLAUDETTE BULLEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 202-966-2033