Provider Demographics
NPI:1366508731
Name:BETHESDA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BETHESDA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRODNICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-897-0357
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-897-0357
Mailing Address - Fax:301-897-2148
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 301
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-897-0357
Practice Address - Fax:301-897-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD375BOtherBCBS (MD)
DCK130OtherBCBS (DC)
MD2130724OtherMAMSI
MD375BOtherBCBS (MD)