Healthcare Provider Details

I. General information

NPI: 1467025395
Provider Name (Legal Business Name): HOT YOGA RIVERDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 RHODE ISLAND AVE STE 200
RIVERDALE PARK MD
20737-1062
US

IV. Provider business mailing address

6202 RHODE ISLAND AVE STE 200
RIVERDALE PARK MD
20737-1062
US

V. Phone/Fax

Practice location:
  • Phone: 301-699-1300
  • Fax:
Mailing address:
  • Phone: 301-699-1300
  • Fax:

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: MRS. KENDRA BLACKETT-DIBINHA
Title or Position: OWNER
Credential:
Phone: 202-288-5745