Provider Demographics
NPI:1053527762
Name:UNIVERSITY PHYSICAL THERAPY ASSOCIATES INC
Entity type:Organization
Organization Name:UNIVERSITY PHYSICAL THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:ZABAIR
Authorized Official - Last Name:ANWAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:301-322-9495
Mailing Address - Street 1:1100 MERCANTILE LANE
Mailing Address - Street 2:#135
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5361
Mailing Address - Country:US
Mailing Address - Phone:301-322-9495
Mailing Address - Fax:301-322-9696
Practice Address - Street 1:1100 MERCANTILE LN STE 135
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5361
Practice Address - Country:US
Practice Address - Phone:301-322-9495
Practice Address - Fax:301-322-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD216682261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216682Medicare ID - Type UnspecifiedORF