NPIMap

Organization Active NPI

Manual & Sports Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Rockville, MD
National Provider Identifier
1447438809
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
19756 Issued in MD
Legal business name
MANUAL & SPORTS PHYSICAL THERAPY LLC
Practice address
121 Congressional LN
Suite 602
Rockville, MD 20852-1542
Phone
(301) 770-1613
Fax
(301) 770-1615
NPI assigned
Feb 7, 2008
Organization subpart
Yes
Parent organization
MANUAL & SPORTS PHYSICAL THERAPY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Ms. Katherine Merrylees Marinos, PTNPI 1316909856
Title
President
Phone
(301) 770-1613

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 19756 MD Primary

Addresses

Primary practice location

121 Congressional LN
Suite 602
Rockville, MD 20852-1542

Mailing address

5 Brighton Ter
Gaithersburg, MD 20877-1814
Phone (301) 330-4693

Other identifiers 1

IdentifierTypeStateIssuer
11249358OtherCAQH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080813000824 DC Part B Supplier - Clinic/Group Practice 7517031586 Receives reassigned benefits from 1 practitioner
Practice locations: Gaithersburg, MD

National Provider Directory

National Provider Directory
Part of
Manual Sports Physical the

Locations

121 Congressional Ln
Ste 602
Rockville, MD 20852
Phone (301) 330-4693

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1447438809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 BRIGHTON TER",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208771814",
            "telephone_number": "301-330-4693",
            "fax_number": "301-330-4693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 CONGRESSIONAL LN",
            "address_2": "SUITE 602",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521542",
            "telephone_number": "301-770-1613",
            "fax_number": "301-770-1615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANUAL & SPORTS PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MANUAL & SPORTS PHYSICAL THERAPY, LLC",
        "enumeration_date": "2008-02-07",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MARINOS",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "MERRYLEES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-770-1613",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MD",
            "license": "19756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11249358",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.