Healthcare Provider Details

I. General information

NPI: 1851899736
Provider Name (Legal Business Name): TYSON TRAINING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 FORBES BLVD STE A
LANHAM MD
20706-4332
US

IV. Provider business mailing address

4501 FORBES BLVD STE A
LANHAM MD
20706-4332
US

V. Phone/Fax

Practice location:
  • Phone: 301-828-7363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number22203
License Number StateMD

VIII. Authorized Official

Name: JOSEPH TYSON
Title or Position: OWNER
Credential:
Phone: 301-828-7363