Healthcare Provider Details

I. General information

NPI: 1235942467
Provider Name (Legal Business Name): PREMISE HEALTH OF MARYLAND MEDICAL P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ORCHARD RIDGE DR
GAITHERSBURG MD
20878-1917
US

IV. Provider business mailing address

5500 MARYLAND WAY STE 120
BRENTWOOD TN
37027-4993
US

V. Phone/Fax

Practice location:
  • Phone: 301-398-6893
  • Fax: 301-398-6893
Mailing address:
  • Phone: 301-398-6893
  • Fax: 301-398-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN B LEIZMAN
Title or Position: PRESIDENT
Credential:
Phone: 216-479-9063