Healthcare Provider Details

I. General information

NPI: 1558902353
Provider Name (Legal Business Name): CAM PHYSICAL THERAPY AND WELLNESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANNAPOLIS RD STE 305
GLENN DALE MD
20769-9183
US

IV. Provider business mailing address

14205 PARK CENTER DR STE 204
LAUREL MD
20707-5252
US

V. Phone/Fax

Practice location:
  • Phone: 301-853-0093
  • Fax: 301-853-0096
Mailing address:
  • Phone: 301-853-0093
  • Fax: 301-853-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JANESA PAVER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 301-853-0093