Provider Demographics
NPI:1629285010
Name:PHYSICAL THERAPY & SPORTS ASSESSMENT CENTER,11
Entity Type:Organization
Organization Name:PHYSICAL THERAPY & SPORTS ASSESSMENT CENTER,11
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LANGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:301-567-7877
Mailing Address - Street 1:6196 OXON HILL RD
Mailing Address - Street 2:SUITE #510
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3100
Mailing Address - Country:US
Mailing Address - Phone:301-567-7877
Mailing Address - Fax:301-839-8034
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:SUITE #510
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-567-7877
Practice Address - Fax:301-839-8034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD750195Medicare ID - Type Unspecified