Individual
EMIKA EMBRACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
11325 PEMBROOKE SQ, SUITE 115, WALDORF, MD 20603-4807
(301) 719-2555
Mailing address
8926 WOODYARD RD, SUITE 701, CLINTON, MD 20735-4220
(301) 856-1682
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
22690
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166204YZW
DC MEDICARE PTAN
—
01
—
22690
MARYLAND LICENSE
—
01
—
46950036
CAREFIRST BCBS NCA
—
01
—
94834201
CAREFIRST BCBS MARYLAND
—
Enumeration date
12/09/2008
Last updated
02/25/2011
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