| Organization Name: | PHYSICAL THERAPY & WELLNESS CENTER |
| NPI Number: | 1184944266 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NEJAMA GRANADA (MANAGER) |
| Mailing Address: | 1809 B East Joppa Road Parkville |
| State: | MD US |
| Postal Code: | 21234 |
| Phone Number: | 4106651165 |
| Fax Number: | 4106651165 |
| NPI Enumeration Date: | 06/11/2010 |
| NPI Last Update Date: | 06/11/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 19135 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |