Provider Demographics
NPI:1437697810
Name:POTOMAC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:POTOMAC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HAMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:786-616-5900
Mailing Address - Street 1:5347 N WILLIAMS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-6210
Mailing Address - Country:US
Mailing Address - Phone:786-616-5900
Mailing Address - Fax:
Practice Address - Street 1:5347 N WILLIAMS CREEK DR
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-6210
Practice Address - Country:US
Practice Address - Phone:786-616-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206271261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy