Provider Demographics
NPI:1356718696
Name:SILVER SPRING PHYSICAL THERAPY CENTER, LLC
Entity type:Organization
Organization Name:SILVER SPRING PHYSICAL THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:T.
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:CORT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:202-369-7741
Mailing Address - Street 1:344 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1948
Mailing Address - Country:US
Mailing Address - Phone:301-593-1067
Mailing Address - Fax:
Practice Address - Street 1:344 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 111
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1948
Practice Address - Country:US
Practice Address - Phone:301-593-1067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17490261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy