Provider Demographics
NPI:1639569015
Name:MONTGOMERY PEDIATRIC PHYSICAL THERAPY CENTER
Entity Type:Organization
Organization Name:MONTGOMERY PEDIATRIC PHYSICAL THERAPY CENTER
Other - Org Name:MOCO MOVEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:301-770-5437
Mailing Address - Street 1:5268 NICHOLSON LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1009
Mailing Address - Country:US
Mailing Address - Phone:240-397-6750
Mailing Address - Fax:301-668-7008
Practice Address - Street 1:5268 NICHOLSON LN
Practice Address - Street 2:SUITE A
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1009
Practice Address - Country:US
Practice Address - Phone:240-397-6750
Practice Address - Fax:301-668-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty