Provider Demographics
NPI:1447438809
Name:MANUAL & SPORTS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MANUAL & SPORTS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:MERRYLEES
Authorized Official - Last Name:MARINOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-770-1613
Mailing Address - Street 1:5 BRIGHTON TER
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1814
Mailing Address - Country:US
Mailing Address - Phone:301-330-4693
Mailing Address - Fax:301-330-4693
Practice Address - Street 1:121 CONGRESSIONAL LN
Practice Address - Street 2:SUITE 602
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:301-770-1613
Practice Address - Fax:301-770-1615
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANUAL & SPORTS PHYSICAL THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19756261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
11249358OtherCAQH
MD=========OtherBUSINESS TAX ID NUMBER
MD=========OtherBUSINESS TAX ID NUMBER