NPIMap

Organization Active NPI

Primephysicaltherapyllc

  • Physical Therapy Clinic/Center
  • Eldersburg, MD
National Provider Identifier
1154868172
Registry record updated Nov 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
23717 Issued in MD
Legal business name
PRIMEPHYSICALTHERAPYLLC
Practice address
1332 Londontown Blvd
Eldersburg, MD 21784-6587
Phone
(443) 531-5888
Fax
(410) 877-2002
NPI assigned
Jan 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2017

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

Authorized official

Name
Mr. Won Yoo, P.T., D.P.T.NPI 1821386269
Title
Owner
Phone
(757) 615-8409

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 23717 MD Primary

Addresses

Primary practice location

1332 Londontown Blvd
Eldersburg, MD 21784-6587

Mailing address

1332 Londontown Blvd
Eldersburg, MD 21784-6587
Phone (443) 531-5888

Other identifiers 1

IdentifierTypeStateIssuer
3099202 00MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171207002215 MD Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7012274525 Receives reassigned benefits from 11 practitioners
Practice locations: Annapolis, MD; Columbia, MD; Eldersburg, MD

National Provider Directory

National Provider Directory

Locations

1789 McGuckian St
Annapolis, MD 21401
Phone (443) 531-5888

9017 Red Branch Rd
Ste A
Columbia, MD 21045
Phone (443) 531-5888

1332 Londontown Blvd
Ste 101
Eldersburg, MD 21784
Phone (443) 531-5888

6300 Georgetown Blvd
Ste 137
Eldersburg, MD 21784

6300 Georgetown Blvd
Ste 101
Sykesville, MD 21784
Phone (443) 531-5888

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1485561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511827200000",
    "number": "1154868172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1332 LONDONTOWN BLVD",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846587",
            "telephone_number": "443-531-5888",
            "fax_number": "410-877-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1332 LONDONTOWN BLVD",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846587",
            "telephone_number": "443-531-5888",
            "fax_number": "410-877-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMEPHYSICALTHERAPYLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-28",
        "last_updated": "2017-11-28",
        "status": "A",
        "authorized_official_last_name": "YOO",
        "authorized_official_first_name": "WON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-615-8409",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T., D.P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MD",
            "license": "23717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3099202 00",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldersburg, 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.