Provider Demographics
NPI:1952671075
Name:MONTCLAIRE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MONTCLAIRE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BIEN-AIME
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-620-7777
Mailing Address - Street 1:700 MONTCLAIRE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4577
Mailing Address - Country:US
Mailing Address - Phone:301-620-7777
Mailing Address - Fax:301-769-5773
Practice Address - Street 1:700 MONTCLAIRE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4577
Practice Address - Country:US
Practice Address - Phone:301-620-7777
Practice Address - Fax:301-769-5773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20593261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy