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General NPI Number Information
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NPI Number | 1366508731
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Entity Type | Organization
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Legal Business Name | BETHESDA PHYSICAL THERAPY
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6410 ROCKLEDGE DR SUITE 301
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City | BETHESDA
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State | MD
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Zip | 20817-1809
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Country | US
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Telephone | 301-897-0357
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Fax | 301-897-2148
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Provider Business Mailing Address
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Address Line | 6410 ROCKLEDGE DR SUITE 301
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City | BETHESDA
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State | MD
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Zip | 20817-1809
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Country | US
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Telephone | 301-897-0357
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Fax | 301-897-2148
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALLEN P BRODNICK
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Credential | P.T.
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Telephone | 301-897-0357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15634
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License Number State | MD
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