MEDICARE: DONNA CONCEPCION P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	168919ZAKW	OTHER		MARYLAND MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	46950040	OTHER		CAREFIRST NCA
3	21516	OTHER	MD	LICENSE #
4	64731703	OTHER		CAREFIRST OF MARYLAND

General Provider Information

NPI Number	:	1235249962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA CONCEPCION P.T.

Provider Business Mailing Address
First Line	:	8926 WOODYARD RD
Second Line	:	SUITE 701
City	:	CLINTON
State	:	MD
Zip	:	20735-4220
Country	:	US
Telephone Number	:	301-856-1682
Fax Number	:

Provider Business Practice Location Address
First Line	:	11325 PEMBROOKE SQ
Second Line	:	SUITE 115
City	:	WALDORF
State	:	MD
Zip	:	20603-4807
Country	:	US
Telephone Number	:	301-638-5313
Fax Number	:	301-638-5343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/20/2011

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Directions to “ DONNA CONCEPCION P.T.” Practice Location

Language	Start Address	Practice Location

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