Provider Demographics
NPI:1982337424
Name:PHYSICAL THERAPY AND PAIN MANAGEMENT CENTER LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND PAIN MANAGEMENT CENTER LLC
Other - Org Name:COLLEGE PARK PHYSICAL THERAPY & HAND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-592-8200
Mailing Address - Street 1:4595 VAN BUREN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1080
Mailing Address - Country:US
Mailing Address - Phone:301-864-0009
Mailing Address - Fax:301-864-0012
Practice Address - Street 1:4595 VAN BUREN ST STE 210
Practice Address - Street 2:
Practice Address - City:RIVERDALE PARK
Practice Address - State:MD
Practice Address - Zip Code:20737-1080
Practice Address - Country:US
Practice Address - Phone:301-864-0009
Practice Address - Fax:301-864-0012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICAL THERAPY AND PAIN MANAGEMENT CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-01
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment