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General NPI Number Information
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NPI Number | 1598900219
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Entity Type | Individual
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Provider Name | EMIKA EMBRACK P.T.
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Gender | Male
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 11325 PEMBROOKE SQ SUITE 115
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City | WALDORF
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State | MD
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Zip | 20603-4807
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Country | US
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Telephone | 301-719-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 8926 WOODYARD RD SUITE 701
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City | CLINTON
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State | MD
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Zip | 20735-4220
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Country | US
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Telephone | 301-856-1682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 22690
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License Number State | MD
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