# 4140 OLD WASHINGTON HIGHWAY OPERATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Waldorf Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740634120
- **Authorized official:** MICHAEL T. BERG (ASSISTANT SECRETARY)
- **Authorized official phone:** (505) 468-4752

## Contact information

- **Practice address:** 4140 OLD WASHINGTON RD, WALDORF, MD 20602-3221
- **Practice address phone:** (301) 645-2813
- **Mailing address:** 4140 OLD WASHINGTON RD, WALDORF, MD 20602-3221
- **Mailing address phone:** (301) 645-2813

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 08006 | MD | Yes |
| 225X00000X | Occupational Therapist | 08006 | MD | — |

## Other

- **Enumeration date:** 04/21/2016
- **Last updated:** 09/07/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 445514200 | — | MD |