Provider Demographics
NPI:1285003038
Name:POTOMAC HEALTH AND EDUCATION GROUP
Entity Type:Organization
Organization Name:POTOMAC HEALTH AND EDUCATION GROUP
Other - Org Name:POTOMAC HEALTH GROUP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:CUBA
Authorized Official - Last Name:RUTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:301-881-1885
Mailing Address - Street 1:6278 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4119
Mailing Address - Country:US
Mailing Address - Phone:240-750-9966
Mailing Address - Fax:301-299-2382
Practice Address - Street 1:6278 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4119
Practice Address - Country:US
Practice Address - Phone:240-750-9966
Practice Address - Fax:301-299-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD574111400Medicaid
MD355103200Medicaid