Provider Demographics
NPI:1982061800
Name:PEDIATRIC PHYSICAL THERAPY AND YOGA
Entity Type:Organization
Organization Name:PEDIATRIC PHYSICAL THERAPY AND YOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:301-538-0847
Mailing Address - Street 1:11325 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6701
Mailing Address - Country:US
Mailing Address - Phone:301-538-0847
Mailing Address - Fax:
Practice Address - Street 1:47 E SOUTH ST
Practice Address - Street 2:SUITE 1-A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5980
Practice Address - Country:US
Practice Address - Phone:301-538-0847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy