Provider Demographics
NPI:1336662139
Name:GEORGALLAS PHYSIOTHERAPY, LLC
Entity Type:Organization
Organization Name:GEORGALLAS PHYSIOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAMBROS
Authorized Official - Middle Name:C
Authorized Official - Last Name:GEORGALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:240-388-5035
Mailing Address - Street 1:11820 GREGERSCROFT RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11820 GREGERSCROFT RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2143
Practice Address - Country:US
Practice Address - Phone:240-388-5035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty