Provider Demographics
NPI:1447377288
Name:EARLY INTERVENTION ASSOCIATES, LLC
Entity type:Organization
Organization Name:EARLY INTERVENTION ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRISTANN
Authorized Official - Middle Name:DB
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:301-468-9343
Mailing Address - Street 1:3204 TOWER OAKS BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-468-9343
Mailing Address - Fax:301-230-2127
Practice Address - Street 1:3204 TOWER OAKS BLVD.
Practice Address - Street 2:SUITE 150
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-468-9343
Practice Address - Fax:301-230-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========Medicare UPIN