Healthcare Provider Details

I. General information

NPI: 1053527762
Provider Name (Legal Business Name): UNIVERSITY PHYSICAL THERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MERCANTILE LN STE 135
LARGO MD
20774-5361
US

IV. Provider business mailing address

1100 MERCANTILE LANE #135
LARGO MD
20774-5361
US

V. Phone/Fax

Practice location:
  • Phone: 301-322-9495
  • Fax: 301-322-9696
Mailing address:
  • Phone: 301-322-9495
  • Fax: 301-322-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number216682
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. MUHAMMAD ZABAIR ANWAR
Title or Position: VICE PRESIDENT
Credential: PHYSICAL THERAPIST
Phone: 301-322-9495