Healthcare Provider Details

I. General information

NPI: 1649659392
Provider Name (Legal Business Name): GREENBELT PHYSICAL THERAPY & SPORTS MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7241 HANOVER PKWY SUITE A
GREENBELT MD
20770-3604
US

IV. Provider business mailing address

7233 HANOVER PKWY SUITE B
GREENBELT MD
20770-3600
US

V. Phone/Fax

Practice location:
  • Phone: 301-477-1987
  • Fax: 301-477-1988
Mailing address:
  • Phone: 301-474-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEVINDER PABLA
Title or Position: PRESIDENT
Credential:
Phone: 240-565-9563