Active NPI
Rachael Omole
- Physical Therapist
- Glenn Dale, MD
National Provider Identifier
1104330208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 26751
- Practice address
- 12200 Annapolis Rd Ste 119
Glenn Dale, MD 20769-9182 - Phone
- (301) 805-5006
- NPI assigned
- Nov 28, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 26751 | MD | Primary |
Addresses
Primary practice location
12200 Annapolis Rd Ste 119
Glenn Dale, MD 20769-9182
Mailing address
12200 Annapolis Rd Ste 119
Glenn Dale, MD 20769-9182
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26751 | MD | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sports Pro Physical Therapy LLC. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Glenn Dale, MD
- NPI 1932576378
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511827200000",
"number": "1104330208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12200 ANNAPOLIS RD STE 119",
"city": "GLENN DALE",
"state": "MD",
"postal_code": "207699182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12200 ANNAPOLIS RD STE 119",
"city": "GLENN DALE",
"state": "MD",
"postal_code": "207699182",
"telephone_number": "301-805-5006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OMOLE",
"first_name": "RACHAEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-28",
"last_updated": "2017-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "26751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenn Dale, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.