Provider Demographics
NPI:1982176988
Name:EVIDENCE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:EVIDENCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HASSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-352-8370
Mailing Address - Street 1:12150 ANNAPOLIS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9183
Mailing Address - Country:US
Mailing Address - Phone:301-352-8370
Mailing Address - Fax:301-352-8372
Practice Address - Street 1:7801 OLD BRANCH AVE STE 105
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1641
Practice Address - Country:US
Practice Address - Phone:301-856-8386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVIDENCE PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty