Provider Demographics
NPI:1669833661
Name:KAYMON PHYSICAL THERAPY AND ASSOCIATES
Entity Type:Organization
Organization Name:KAYMON PHYSICAL THERAPY AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:EARLENE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:240-245-0476
Mailing Address - Street 1:9201 EDGEWORTH DR
Mailing Address - Street 2:#4251
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20791-7501
Mailing Address - Country:US
Mailing Address - Phone:240-245-0476
Mailing Address - Fax:202-204-5637
Practice Address - Street 1:9201 EDGEWORTH DR
Practice Address - Street 2:#4251
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20791-7501
Practice Address - Country:US
Practice Address - Phone:240-245-0476
Practice Address - Fax:202-204-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23062261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy