Provider Demographics
NPI:1730564394
Name:PHYSIOCARE REHAB & WELLNESS, LLC
Entity type:Organization
Organization Name:PHYSIOCARE REHAB & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:OFORI-ANSAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:240-460-0960
Mailing Address - Street 1:7651 MATAPEAKE BUSINESS DR # 203
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-3038
Mailing Address - Country:US
Mailing Address - Phone:301-782-4600
Mailing Address - Fax:301-782-4601
Practice Address - Street 1:7651 MATAPEAKE BUSINESS DR STE 203
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3038
Practice Address - Country:US
Practice Address - Phone:443-583-4180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22667261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy