MEDICARE: AMY CONCHILLA

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	21123	MD

General Provider Information

NPI Number	:	1891858098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY CONCHILLA

Provider Business Mailing Address
First Line	:	6410 ROCKLEDGE DR
Second Line	:	NRH REGIONAL REHAB - SUITE 600
City	:	BETHESDA
State	:	MD
Zip	:	20817-1809
Country	:	US
Telephone Number	:	301-581-8054
Fax Number	:	301-564-0284

Provider Business Practice Location Address
First Line	:	12140 CENTRAL AVE
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-1932
Country	:	US
Telephone Number	:	301-581-8054
Fax Number	:	301-564-0284

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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Directions to “ AMY CONCHILLA ” Practice Location

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