# VITAL SELF PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578909487
- **Authorized official:** LAUREN H COLLINS MPT, CLT-LANA (PHYSICAL THERAPIST)
- **Authorized official phone:** (313) 550-6367

## Contact information

- **Practice address:** 7610 PENNSYLVANIA AVE, FORESTVILLE, MD 20747-4701
- **Practice address phone:** (313) 550-6367
- **Practice address fax:** (301) 669-1873
- **Mailing address:** 7610 PENNSYLVANIA AVE, FORESTVILLE, MD 20747-4701
- **Mailing address phone:** (313) 550-6367
- **Mailing address fax:** (301) 669-1873

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 24460 | MD | Yes |

## Other

- **Enumeration date:** 05/18/2013
- **Last updated:** 06/18/2013