MEDICARE: EMIKA EMBRACK 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	22690	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	166204YZW	OTHER		DC MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	94834201	OTHER	CAREFIRST BCBS MARYLAND
3	46950036	OTHER	CAREFIRST BCBS NCA
4	22690	OTHER	MARYLAND LICENSE

General Provider Information

NPI Number	:	1598900219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMIKA EMBRACK 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	:	301-719-2555
Fax Number	:

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

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	02/25/2011

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Directions to “ EMIKA EMBRACK P.T.” Practice Location

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