Provider Demographics
NPI:1437851334
Name:NATIVE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:NATIVE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAT
Authorized Official - Middle Name:
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-738-3967
Mailing Address - Street 1:4905 ROCKINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1055
Mailing Address - Country:US
Mailing Address - Phone:781-738-3967
Mailing Address - Fax:
Practice Address - Street 1:801 COMPASS WAY STE 208
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7818
Practice Address - Country:US
Practice Address - Phone:443-837-5741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty