Organization Name: | VITAL SELF PHYSICAL THERAPY, LLC |
NPI Number: | 1578909487 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAUREN H COLLINS (PHYSICAL THERAPIST) |
Mailing Address: | 7610 Pennsylvania Ave Forestville |
State: | MD US |
Postal Code: | 207474701 |
Phone Number: | 3135506367 |
Fax Number: | 3016691873 |
NPI Enumeration Date: | 05/18/2013 |
NPI Last Update Date: | 06/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 24460 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |