# EVIDENCE PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EvidencePT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265162473
- **Authorized official:** HASSANA MOSES SHRM-CP (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (301) 352-8370

## Contact information

- **Practice address:** 12150 ANNAPOLIS RD STE 201, GLENN DALE, MD 20769-9183
- **Practice address phone:** (301) 352-8370
- **Practice address fax:** (301) 352-8372
- **Mailing address:** 12150 ANNAPOLIS RD STE 201, GLENN DALE, MD 20769-9183
- **Mailing address phone:** (301) 352-8370

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 06/13/2022
- **Last updated:** 06/13/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 533704600 | — | MD |
| 05 | — | 533704601 | — | MD |
| 01 | — | 616235300 | DEPARTMENT OF LABOR | MD |