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General NPI Number Information
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NPI Number | 1144821307
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Entity Type | Organization
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Legal Business Name | MY CONCIERGE PT LLC
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 9141 GRACIOUS END CT APT 104
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City | COLUMBIA
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State | MD
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Zip | 21046-2095
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Country | US
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Telephone | 240-461-6306
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Fax |
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Provider Business Mailing Address
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Address Line | 9141 GRACIOUS END CT APT 104
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City | COLUMBIA
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State | MD
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Zip | 21046-2095
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Country | US
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Telephone | 240-461-6306
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Fax |
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Authorized Official
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Title or Position | CEO/PHYSICAL THERAPIST
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Name | REENA GOPINATHAN
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Credential | PT
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Telephone | 240-461-6306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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