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General NPI Number Information
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NPI Number | 1710574512
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Entity Type | Individual
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Provider Name | SREEJESH KUMAR RAJEEVA KUMAR DPT
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Gender | Male
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 6426 MADIGAN TRL
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City | FREDERICK
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State | MD
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Zip | 21703-7376
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Country | US
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Telephone | 202-394-3916
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Fax |
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Provider Business Mailing Address
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Address Line | 6426 MADIGAN TRL
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City | FREDERICK
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State | MD
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Zip | 21703-7376
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Country | US
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Telephone | 202-394-3916
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 24273
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License Number State | MD
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