Provider Demographics
NPI:1437182177
Name:SENECA PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SENECA PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROLLE
Authorized Official - Suffix:III
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:301-948-4395
Mailing Address - Street 1:15201 SHADY GROVE RD
Mailing Address - Street 2:# 106
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-948-4395
Mailing Address - Fax:301-840-8972
Practice Address - Street 1:15201 SHADY GROVE RD
Practice Address - Street 2:# 106
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-948-4395
Practice Address - Fax:301-840-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00325Medicare ID - Type Unspecified