=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942069059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHAB & FITNESS PARADISE - PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2024
-----------------------------------------------------
Last Update Date | 03/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10125 WESLEIGH DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21046-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-755-3382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10125 WESLEIGH DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21046-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-755-3382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF PHYSICAL THERAPY
-----------------------------------------------------
Name | DR. LUIS ARRIAZA
-----------------------------------------------------
Credential | DPT, ATC
-----------------------------------------------------
Telephone | 301-755-3382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------