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General NPI Number Information
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NPI Number | 1407971989
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Entity Type | Organization
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Legal Business Name | LIVINGWELL PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1400 MERCANTILE LN SUITE 184
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City | LARGO
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State | MD
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Zip | 20774-5341
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Country | US
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Telephone | 301-772-4001
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Fax | 301-773-4003
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Provider Business Mailing Address
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Address Line | 1400 MERCANTILE LN SUITE 184
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City | LARGO
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State | MD
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Zip | 20774-5341
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Country | US
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Telephone | 301-772-4001
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Fax | 301-773-4003
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OWNER
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Name | MS. LOVINA TRAMEL BROWN
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Credential | PT
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Telephone | 301-772-4001
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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 | 17940
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License Number State | MD
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