Healthcare Provider Details

I. General information

NPI: 1538792148
Provider Name (Legal Business Name): EAMAN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 SHADY GROVE RD STE 202
ROCKVILLE MD
20850-6207
US

IV. Provider business mailing address

19785 CRYSTAL ROCK DR STE 309
GERMANTOWN MD
20874-4732
US

V. Phone/Fax

Practice location:
  • Phone: 240-724-6781
  • Fax: 888-607-7117
Mailing address:
  • Phone: 240-686-5225
  • Fax: 240-260-1387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TAREK A HASSAN
Title or Position: DIRECTOR
Credential:
Phone: 240-686-5225