Provider Demographics
NPI:1932815750
Name:CORE FOUNDATIONS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CORE FOUNDATIONS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIOROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:912-257-0031
Mailing Address - Street 1:17005 OVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1555
Mailing Address - Country:US
Mailing Address - Phone:410-885-0454
Mailing Address - Fax:888-286-0805
Practice Address - Street 1:17005 OVERHILL RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-1555
Practice Address - Country:US
Practice Address - Phone:410-885-0454
Practice Address - Fax:888-286-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty