Provider Demographics
NPI:1669013462
Name:CAM PHYSICAL THERAPY AND WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:CAM PHYSICAL THERAPY AND WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-853-0093
Mailing Address - Street 1:14205 PARK CENTER DR STE 204
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5252
Mailing Address - Country:US
Mailing Address - Phone:301-853-0093
Mailing Address - Fax:301-853-0096
Practice Address - Street 1:3311 TOLEDO TER STE A1
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4136
Practice Address - Country:US
Practice Address - Phone:301-853-0093
Practice Address - Fax:301-853-0096
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAM PHYSICAL THERAPY AND WELLNESS SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-02
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD336305800Medicaid