Healthcare Provider Details

I. General information

NPI: 1174161855
Provider Name (Legal Business Name): FINAL FORM PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 ANNAPOLIS RD
LANHAM MD
20706-3025
US

IV. Provider business mailing address

9470 ANNAPOLIS RD
LANHAM MD
20706-3025
US

V. Phone/Fax

Practice location:
  • Phone: 301-938-7322
  • Fax:
Mailing address:
  • Phone: 301-938-7322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SEAN O EKEKWE
Title or Position: CEO
Credential:
Phone: 301-938-7322