MEDICARE: ABUNDANT LIFE PHYSICAL THERAPY 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	261QP2000X	Physical Therapy Clinic/Center	23304	MD

General Provider Information

NPI Number	:	1831527332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT LIFE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	2803 FALLING BROOK TER
Second Line	:
City	:	ADELPHI
State	:	MD
Zip	:	20783-1451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2803 FALLING BROOK TER
Second Line	:
City	:	ADELPHI
State	:	MD
Zip	:	20783-1451
Country	:	US
Telephone Number	:	240-388-7255
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHARONDA BYNUM
Credential	:
Telephone Number	:	240-388-7255

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	10/17/2013

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