Provider Demographics
NPI:1689927055
Name:CORE CARE PHYSICAL THERAPY & WELLNESS LLC
Entity Type:Organization
Organization Name:CORE CARE PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:HINE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:301-801-6818
Mailing Address - Street 1:3101 DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2335
Mailing Address - Country:US
Mailing Address - Phone:301-801-6818
Mailing Address - Fax:
Practice Address - Street 1:10750 COLUMBIA PIKE STE 401B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4457
Practice Address - Country:US
Practice Address - Phone:301-592-1500
Practice Address - Fax:301-592-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
MD18112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD328402600Medicaid