Provider Demographics
NPI:1700184611
Name:POTOMAC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:POTOMAC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:301-567-8856
Mailing Address - Street 1:3010 CRAIN HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2801
Mailing Address - Country:US
Mailing Address - Phone:301-567-8856
Mailing Address - Fax:
Practice Address - Street 1:3010 CRAIN HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2801
Practice Address - Country:US
Practice Address - Phone:301-567-8856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty