Organization
LA PLATA PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE CUNNINGHAM (CEO)
(301) 392-3700
Entity
Organization
Contact information
Practice address
101 CENTENNIAL ST, SUITE C, LA PLATA, MD 20646-5975
(301) 392-3700
(301) 392-3876
Mailing address
P.O. BOX 1732, LA PLATA, MD 20646
(301) 391-3700
(301) 392-3876
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
15290
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T628
BLUE CROSS
DC
Enumeration date
10/09/2007
Last updated
09/05/2008
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