Healthcare Provider Details

I. General information

NPI: 1447881396
Provider Name (Legal Business Name): NAVAH PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 KETTERING DR
UPPER MARLBORO MD
20774-1676
US

IV. Provider business mailing address

77 KETTERING DR
UPPER MARLBORO MD
20774-1676
US

V. Phone/Fax

Practice location:
  • Phone: 240-312-2010
  • Fax: 240-312-2010
Mailing address:
  • Phone: 240-312-2010
  • Fax: 240-312-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMILA CSHATEL RAWLINGS LOGAN
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 301-793-1082