Vital Self Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

24460 Issued in MD

Legal business name

VITAL SELF PHYSICAL THERAPY, LLC

Practice address

7610 Pennsylvania Ave
Forestville, MD 20747-4701

Phone

(313) 550-6367

Fax

(301) 669-1873

NPI assigned

May 18, 2013

Last updated

Jun 18, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lauren H Collins, MPT, CLT-LANANPI 1417194655

Title

Physical Therapist

Phone

(313) 550-6367

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Lauren Hallie Collins, DPT, PWCS, CLT

  • Physical Therapist
  • Bowie, MD
  • NPI 1417194655
  Authorized official Same address or phone

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

{
    "created_epoch": "1368835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371513600000",
    "number": "1578909487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7610 PENNSYLVANIA AVE",
            "city": "FORESTVILLE",
            "state": "MD",
            "postal_code": "207474701",
            "telephone_number": "313-550-6367",
            "fax_number": "301-669-1873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7610 PENNSYLVANIA AVE",
            "city": "FORESTVILLE",
            "state": "MD",
            "postal_code": "207474701",
            "telephone_number": "313-550-6367",
            "fax_number": "301-669-1873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL SELF PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-18",
        "last_updated": "2013-06-18",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "313-550-6367",
        "authorized_official_credential": "MPT, CLT-LANA"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MD",
            "license": "24460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Forestville, MD
• Providers in Forestville, MD by specialty
• Physical Therapy Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2013; 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.