NPIMap

Organization Active NPI

Prestige Physical Therapy LLC

  • Specialist
  • Clarksburg, MD
National Provider Identifier
1124263066
Registry record updated Dec 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PRESTIGE PHYSICAL THERAPY LLC
Practice address
23202 Brewers Tavern Way
Clarksburg, MD 20871-4391
Phone
(240) 207-3090
Fax
(240) 207-2182
NPI assigned
Dec 5, 2008
Last updated
Dec 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Richard E Dixon Jr.
Title
Owner
Phone
(240) 207-3090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

23202 Brewers Tavern Way
Clarksburg, MD 20871-4391

Mailing address

23202 Brewers Tavern Way
Clarksburg, MD 20871-4391
Phone (240) 207-3090

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230076800000",
    "number": "1124263066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23202 BREWERS TAVERN WAY",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208714391",
            "telephone_number": "240-207-3090",
            "fax_number": "240-207-2182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23202 BREWERS TAVERN WAY",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208714391",
            "telephone_number": "240-207-3090",
            "fax_number": "240-207-2182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-05",
        "last_updated": "2008-12-24",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-207-3090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.