Organization
AAA PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROEL MANUEL EVANGELISTA (MANAGING MEMBER)
(443) 979-7171
Entity
Organization
Contact information
Practice address
6955 OAKLAND MILLS RD, STE E, COLUMBIA, MD 21045-5849
(443) 979-7171
(667) 200-5908
Mailing address
6955 OAKLAND MILLS RD, STE E, COLUMBIA, MD 21045-5849
(443) 979-7171
(667) 200-5908
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
22980
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
228850
MEDICARE
MD
05
—
523804800
—
MD
Enumeration date
12/05/2016
Last updated
12/05/2016
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