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General NPI Number Information
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NPI Number | 1902724586
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Entity Type | Individual
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Provider Name | ROGER PACKARD PTA
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Gender | Male
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 9909 MEDICAL CENTER DR
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City | ROCKVILLE
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State | MD
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Zip | 20850-6361
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Country | US
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Telephone | 124-086-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 7985 MARTOWN RD
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City | LAUREL
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State | MD
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Zip | 20723-1147
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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 |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2132728
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License Number State | TX
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