Healthcare Provider Details

I. General information

NPI: 1043864960
Provider Name (Legal Business Name): PHYSIOCARE REHAB & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10631 GREENBELT RD STE 303
LANHAM MD
20706-2282
US

IV. Provider business mailing address

7651 MATAPEAKE BUSINESS DR STE 203
BRANDYWINE MD
20613-3042
US

V. Phone/Fax

Practice location:
  • Phone: 301-782-4600
  • Fax:
Mailing address:
  • Phone: 301-782-4600
  • Fax: 301-782-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KWABENA OFORI-ANSAH
Title or Position: PRESIDENT/CEO
Credential: DPT
Phone: 240-460-0960