MEDICARE: WASHINGTON WELLNESS CENTER FOR PHYSICAL THERAPY AND SPORTSCARE, 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1902349715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON WELLNESS CENTER FOR PHYSICAL THERAPY AND SPORTSCARE, LLC

Provider Business Mailing Address
First Line	:	25 MASSACHUSETTS AVE NW
Second Line	:	SUITE C 300
City	:	WASHINGTON
State	:	DC
Zip	:	20001-1430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 H ST NW
Second Line	:	SUITE LL 110
City	:	WASHINGTON
State	:	DC
Zip	:	20005-5476
Country	:	US
Telephone Number	:	202-347-2373
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY LEININGER
Credential	:	PT, DPT
Telephone Number	:	202-347-2373

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	11/28/2016

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