Healthcare Provider Details

I. General information

NPI: 1790901064
Provider Name (Legal Business Name): WILMA A COROS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 DEMOCRACY BLVD STE 504
BETHESDA MD
20817-1166
US

IV. Provider business mailing address

126 MCCLELLAN DR
FREDERICK MD
21702-5502
US

V. Phone/Fax

Practice location:
  • Phone: 301-637-8712
  • Fax:
Mailing address:
  • Phone: 301-663-7826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21458
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008156
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: