Provider Demographics
NPI:1275659609
Name:PERSONALIZED REHAB & EXERCISE INC.
Entity Type:Organization
Organization Name:PERSONALIZED REHAB & EXERCISE INC.
Other - Org Name:WCDI PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-897-5655
Mailing Address - Street 1:4303 COLCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-4020
Mailing Address - Country:US
Mailing Address - Phone:301-897-5655
Mailing Address - Fax:301-897-8835
Practice Address - Street 1:118 QUINCY ST
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3321
Practice Address - Country:US
Practice Address - Phone:301-897-5655
Practice Address - Fax:301-897-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00A698J24Medicare ID - Type UnspecifiedPROVIDER NUMBER
MDG00624Medicare ID - Type UnspecifiedGROUP NUMBER