Healthcare Provider Details

I. General information

NPI: 1689927055
Provider Name (Legal Business Name): CORE CARE PHYSICAL THERAPY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 COLUMBIA PIKE STE 401B
SILVER SPRING MD
20901-4457
US

IV. Provider business mailing address

3101 DECATUR AVE
KENSINGTON MD
20895-2335
US

V. Phone/Fax

Practice location:
  • Phone: 301-592-1500
  • Fax: 301-592-1506
Mailing address:
  • Phone: 301-801-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18112
License Number StateMD

VIII. Authorized Official

Name: MS. JENNIFER GALE HINE
Title or Position: CEO
Credential: M.P.T.
Phone: 301-801-6818