Healthcare Provider Details

I. General information

NPI: 1568600807
Provider Name (Legal Business Name): MICHAEL R TWOMEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2009
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 GOOD LUCK RD STE 205
LANHAM MD
20706-3508
US

IV. Provider business mailing address

9946 OAK LEA CT
ELLICOTT CITY MD
21042-3638
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-4284
  • Fax: 301-599-9500
Mailing address:
  • Phone: 410-330-9380
  • Fax: 410-580-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17752
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number17752
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: