# EVIDENCE PHYSICAL THERAPY, LLC

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

## Provider details

- **NPI number:** 1972329506
- **Authorized official:** HASSANA MOSES (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (301) 352-8370

## Contact information

- **Practice address:** 14501 BALTIMORE AVE, LAUREL, MD 20707-4901
- **Practice address phone:** (301) 799-9466
- **Practice address fax:** (301) 799-9467
- **Mailing address:** 12150 ANNAPOLIS RD STE 201, GLENN DALE, MD 20769-9183
- **Mailing address phone:** (301) 352-8370
- **Mailing address fax:** (301) 352-8372

## Taxonomy

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

## Other

- **Enumeration date:** 11/27/2024
- **Last updated:** 11/27/2024