MEDICARE: ORTHOPAEDIC MANUAL THERAPY SPECIALISTS, LLC

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	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1699175711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC MANUAL THERAPY SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	13233 EXECUTIVE PARK TER
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2648
Country	:	US
Telephone Number	:	301-327-3400
Fax Number	:	301-296-0741

Provider Business Practice Location Address
First Line	:	13233 EXECUTIVE PARK TER
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-2648
Country	:	US
Telephone Number	:	301-327-3400
Fax Number	:	301-296-0741

Authorized Official
Title or Position	:	PHYSICAL THERAPIST, OWNER
Name	:	DR. JOHN LOGAN COOPER
Credential	:	PT, DPT, OCS, CSCS
Telephone Number	:	301-327-3400

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	09/28/2023

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