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General NPI Number Information
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NPI Number | 1386348357
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Entity Type | Organization
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Legal Business Name | KMG PHYSICAL THERAPY AND CONSULTING LLC
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Dates
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Enumeration Date | 03/27/2023
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 146 HIDDEN HILL CIR
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City | ODENTON
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State | MD
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Zip | 21113-4015
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Country | US
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Telephone | 301-741-7430
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 275
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City | SEVERN
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State | MD
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Zip | 21144-0275
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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/PHYSICAL THERAPIST
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Name | DR. KIESHA GLOVER
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Credential | DPT
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Telephone | 301-741-7430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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