Healthcare Provider Details

I. General information

NPI: 1356718696
Provider Name (Legal Business Name): SILVER SPRING PHYSICAL THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 UNIVERSITY BLVD W SUITE 111
SILVER SPRING MD
20901-1948
US

IV. Provider business mailing address

344 UNIVERSITY BLVD W SUITE 111
SILVER SPRING MD
20901-1948
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-1067
  • Fax:
Mailing address:
  • Phone: 301-593-1067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number17490
License Number StateMD

VIII. Authorized Official

Name: MR. T. GORDON CORT
Title or Position: OWNER
Credential: PT
Phone: 202-369-7741