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General NPI Number Information
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NPI Number | 1760002091
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Entity Type | Organization
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Legal Business Name | DISTRICT CORE PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 3920 LIVINGSTON ST
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City | HYATTSVILLE
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State | MD
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Zip | 20781-1739
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Country | US
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Telephone | 313-286-7142
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 LIVINGSTON ST
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City | HYATTSVILLE
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State | MD
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Zip | 20781-1739
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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
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Name | MIA MONTGOMERY
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Credential |
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Telephone | 313-286-7142
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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 |
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License Number State |
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