Healthcare Provider Details

I. General information

NPI: 1982829693
Provider Name (Legal Business Name): PREMIER PHYSICAL MEDICINE & REHABILITATION, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MERCANTILE LN SUITE 220
LARGO MD
20774-5360
US

IV. Provider business mailing address

PO BOX 6302
CAPITOL HEIGHTS MD
20791-6302
US

V. Phone/Fax

Practice location:
  • Phone: 301-925-1517
  • Fax: 301-925-1674
Mailing address:
  • Phone: 301-925-1517
  • Fax: 301-925-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DENSON TERRY
Title or Position: CEO
Credential:
Phone: 301-925-1517