Provider Demographics
NPI:1982829693
Name:PREMIER PHYSICAL MEDICINE & REHABILITATION, LLC.
Entity Type:Organization
Organization Name:PREMIER PHYSICAL MEDICINE & REHABILITATION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENSON
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-925-1517
Mailing Address - Street 1:PO BOX 6302
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20791-6302
Mailing Address - Country:US
Mailing Address - Phone:301-925-1517
Mailing Address - Fax:301-925-1674
Practice Address - Street 1:1101 MERCANTILE LN
Practice Address - Street 2:SUITE 220
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5360
Practice Address - Country:US
Practice Address - Phone:301-925-1517
Practice Address - Fax:301-925-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00390Medicare ID - Type UnspecifiedMEDICARE NUMBER