Provider Demographics
NPI:1679358220
Name:PHYSICAL THERAPY AND WELLNESS
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:443-421-9480
Mailing Address - Street 1:PO BOX 11711
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-0311
Mailing Address - Country:US
Mailing Address - Phone:443-421-9480
Mailing Address - Fax:
Practice Address - Street 1:28 ELINOR AVE
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4303
Practice Address - Country:US
Practice Address - Phone:443-421-9480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy