Healthcare Provider Details

I. General information

NPI: 1053458562
Provider Name (Legal Business Name): REBECCA B VON KERCZEK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 KENSINGTON PKWY
KENSINGTON MD
20895-2943
US

IV. Provider business mailing address

2101 EAST JEFFERSON ST KAISER PERMANENTE 3 WEST ATTN: SANJAY MATHUR-DATA MGMT
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-897-2330
  • Fax: 301-929-7361
Mailing address:
  • Phone: 301-816-7446
  • Fax: 301-816-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4847
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: