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General NPI Number Information
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NPI Number | 1982061800
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PHYSICAL THERAPY AND YOGA
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 47 E SOUTH ST SUITE 1-A
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City | FREDERICK
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State | MD
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Zip | 21701-5980
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Country | US
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Telephone | 301-538-0847
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Fax |
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Provider Business Mailing Address
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Address Line | 11325 COUNTRY CLUB RD
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City | NEW MARKET
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State | MD
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Zip | 21774-6701
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Country | US
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Telephone | 301-538-0847
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. MONICA JOHNSON
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Credential | DPT
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Telephone | 301-538-0847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | MD
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