Provider Demographics
NPI:1073281549
Name:EGAN PHYSICAL THERAPY LLC.
Entity Type:Organization
Organization Name:EGAN PHYSICAL THERAPY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSC (PHYSIO) CMTPT
Authorized Official - Phone:301-693-3225
Mailing Address - Street 1:4018 GLENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3707
Mailing Address - Country:US
Mailing Address - Phone:301-793-6679
Mailing Address - Fax:
Practice Address - Street 1:7825 TUCKERMAN LN STE 211
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3241
Practice Address - Country:US
Practice Address - Phone:301-701-6877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy