Provider Demographics
NPI:1376731026
Name:LA PLATA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LA PLATA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-392-3700
Mailing Address - Street 1:P.O. BOX 1732
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646
Mailing Address - Country:US
Mailing Address - Phone:301-391-3700
Mailing Address - Fax:301-392-3876
Practice Address - Street 1:101 CENTENNIAL ST
Practice Address - Street 2:SUITE C
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5975
Practice Address - Country:US
Practice Address - Phone:301-392-3700
Practice Address - Fax:301-392-3876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15290208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCT628OtherBLUE CROSS
DCT628OtherBLUE CROSS