Provider Demographics
NPI:1760992556
Name:BETTERU PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BETTERU PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEOVANY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-590-5059
Mailing Address - Street 1:13524 BONNIE DALE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3904
Mailing Address - Country:US
Mailing Address - Phone:301-590-5059
Mailing Address - Fax:
Practice Address - Street 1:8 RUSSELL AVE STE 102
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2962
Practice Address - Country:US
Practice Address - Phone:240-474-5564
Practice Address - Fax:240-474-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy