# RESURGENT PERFORMANCE PT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Resurgent Performance Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174079545
- **Authorized official:** DR. THOMAS FREDERICK VAN ORNUM DPT (OWNER/FOUNDER)
- **Authorized official phone:** (240) 261-6136

## Contact information

- **Practice address:** 16810 OAKMONT AVE, GAITHERSBURG, MD 20877-4110
- **Practice address phone:** (240) 261-6136
- **Mailing address:** 16810 OAKMONT AVE, GAITHERSBURG, MD 20877-4110
- **Mailing address phone:** (240) 261-6136

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 25246 | MD | Yes |

## Other

- **Enumeration date:** 08/26/2016
- **Last updated:** 08/26/2016