NPIMap

Organization Active NPI

Good Shepherd Physical Therapy and Wellness Center,LLC

  • Physical Therapist
  • Rockville, MD
National Provider Identifier
1487141487
Registry record updated Apr 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
24026 Issued in MD
Legal business name
GOOD SHEPHERD PHYSICAL THERAPY AND WELLNESS CENTER,LLC
Practice address
11119 Rockville Pike Ste 316
Rockville, MD 20852-3143
Phone
(301) 771-1344
Fax
(240) 387-7387
NPI assigned
Apr 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2018

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

Authorized official

Name
May Rivera
Title
President
Phone
(301) 771-1344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 24026 MD Primary

Addresses

Primary practice location

11119 Rockville Pike Ste 316
Rockville, MD 20852-3143

Mailing address

11119 Rockville Pike Ste 316
Rockville, MD 20852-3143
Phone (301) 771-1344

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180404002523 DC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4284997230 Receives reassigned benefits from 1 practitioner
Practice locations: Rockville, MD

National Provider Directory

National Provider Directory
Tax ID family
Good Shepherd Physical Therapy and Wellness Centerllc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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": "1523836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523836800000",
    "number": "1487141487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11119 ROCKVILLE PIKE STE 316",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208523143",
            "telephone_number": "301-771-1344",
            "fax_number": "240-387-7387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11119 ROCKVILLE PIKE STE 316",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208523143",
            "telephone_number": "301-771-1344",
            "fax_number": "240-387-7387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD PHYSICAL THERAPY AND WELLNESS CENTER,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-16",
        "last_updated": "2018-04-16",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "MAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-771-1344"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "24026",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 16, 2018; 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.