Provider Demographics
NPI:1902349715
Name:WASHINGTON WELLNESS CENTER FOR PHYSICAL THERAPY AND SPORTSCARE, LLC
Entity Type:Organization
Organization Name:WASHINGTON WELLNESS CENTER FOR PHYSICAL THERAPY AND SPORTSCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEININGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:202-347-2373
Mailing Address - Street 1:25 MASSACHUSETTS AVE NW
Mailing Address - Street 2:SUITE C 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 H ST NW
Practice Address - Street 2:SUITE LL 110
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-5476
Practice Address - Country:US
Practice Address - Phone:202-347-2373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC241894Medicare PIN