Provider Demographics
NPI:1871681296
Name:AMWELL ORTHOPAEDIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:AMWELL ORTHOPAEDIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LUBICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-345-3711
Mailing Address - Street 1:6201 GREENBELT RD
Mailing Address - Street 2:SUITE L-7
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2354
Mailing Address - Country:US
Mailing Address - Phone:301-345-3711
Mailing Address - Fax:301-220-8913
Practice Address - Street 1:6201 GREENBELT RD
Practice Address - Street 2:SUITE L-7
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2354
Practice Address - Country:US
Practice Address - Phone:301-345-3711
Practice Address - Fax:301-220-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18870261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02149Medicare ID - Type UnspecifiedGROUP #