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General NPI Number Information
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NPI Number | 1447435276
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Entity Type | Organization
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Legal Business Name | PHOENIX RISING, PHYSICAL AND MASSAGE THERAPY, LLC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 12/28/2007
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Provider Practice Location Address
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Address Line | 1050 17TH ST NW SUITE 1000
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City | WASHINGTON
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State | DC
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Zip | 20036-5503
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Country | US
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Telephone | 202-496-5305
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Fax |
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Provider Business Mailing Address
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Address Line | 10756 HOLLAWAY DR
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-4735
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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 | PHYSICAL THERAPIST
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Name | KAREN D DURANA
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Credential |
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Telephone | 202-496-5305
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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 | DC2774
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License Number State | DC
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