Healthcare Provider Details

I. General information

NPI: 1245693399
Provider Name (Legal Business Name): WOMEN'S HEALTH PT OF CENTRAL MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 MINSTREL WAY STE LL110
COLUMBIA MD
21045-5261
US

IV. Provider business mailing address

PO BOX 356
BURTONSVILLE MD
20866-0356
US

V. Phone/Fax

Practice location:
  • Phone: 240-841-2639
  • Fax: 301-500-2175
Mailing address:
  • Phone: 301-421-1125
  • Fax: 301-500-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KRISTA RACHEL FREDERIC
Title or Position: MANAGING MEMBER
Credential: PT
Phone: 301-421-1125