Provider Demographics
NPI:1255489092
Name:PHYSICAL AND MASSAGE THERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:PHYSICAL AND MASSAGE THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-966-2033
Mailing Address - Street 1:4000 ALBEMARLE ST NW
Mailing Address - Street 2:#501
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016
Mailing Address - Country:US
Mailing Address - Phone:202-966-2033
Mailing Address - Fax:202-966-2034
Practice Address - Street 1:4000 ALBEMARLE ST NW
Practice Address - Street 2:#501
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016
Practice Address - Country:US
Practice Address - Phone:202-966-2033
Practice Address - Fax:202-966-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCL14860261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01408Medicare ID - Type Unspecified