Healthcare Provider Details

I. General information

NPI: 1912582347
Provider Name (Legal Business Name): PRIMETIME PHYSICAL THERAPY AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 85TH AVE APT 101
LANHAM MD
20706-4515
US

IV. Provider business mailing address

5427 85TH AVE APT 101
LANHAM MD
20706-4515
US

V. Phone/Fax

Practice location:
  • Phone: 240-460-9149
  • Fax:
Mailing address:
  • Phone: 240-460-9149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. EBONY CARSON-PINKNEY
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: PT, DPT
Phone: 240-460-9149