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General NPI Number Information
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NPI Number | 1114730124
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Entity Type | Organization
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Legal Business Name | FREEDOM WELLNESS PHYSIATRY LLC
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 1603 SARATOGA CT
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-4186
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Country | US
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Telephone | 240-339-5377
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Fax |
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Provider Business Mailing Address
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Address Line | 1603 SARATOGA CT
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-4186
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMANTHA BENJAMIN-ALLEN
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Credential | DO
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Telephone | 240-339-5377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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