Provider Demographics
NPI:1598747404
Name:NULIFE PHYSICAL THERAPY P. C.
Entity Type:Organization
Organization Name:NULIFE PHYSICAL THERAPY P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMONTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-498-7693
Mailing Address - Street 1:1324 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-1185
Mailing Address - Country:US
Mailing Address - Phone:301-360-9986
Mailing Address - Fax:
Practice Address - Street 1:14701 LEE HWY
Practice Address - Street 2:SUITE # 206
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2114
Practice Address - Country:US
Practice Address - Phone:571-215-5061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305102993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty