NPIMap

Organization Active NPI

Functional Physical Therapy, LLC

  • Orthopedic Physical Therapist
  • Rockville, MD
National Provider Identifier
1730604745
Registry record updated Aug 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
26474 Issued in MD
Legal business name
FUNCTIONAL PHYSICAL THERAPY, LLC
Practice address
103 N Adams St Ste 1-2
Rockville, MD 20850-2256
Phone
(301) 602-3117
NPI assigned
Aug 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2017

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

Authorized official

Name
Gabriela Van Sickle, PT, DPT, CMFTNPI 1770912032
Title
Owner/Physical Therapist
Phone
(301) 602-3117

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
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X 26474 MD Primary

Addresses

Primary practice location

103 N Adams St Ste 1-2
Rockville, MD 20850-2256

Mailing address

7509 Old Chapel Dr
Bowie, MD 20715-6011
Phone (301) 602-3117

National Provider Directory

National Provider Directory

Locations

103 N Adams St
Ste 12
Rockville, MD 20850
Phone (301) 602-3117

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": "1502323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502323200000",
    "number": "1730604745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7509 OLD CHAPEL DR",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207156011",
            "telephone_number": "301-602-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N ADAMS ST STE 1-2",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208502256",
            "telephone_number": "301-602-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-10",
        "last_updated": "2017-08-10",
        "status": "A",
        "authorized_official_last_name": "VAN SICKLE",
        "authorized_official_first_name": "GABRIELA",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "301-602-3117",
        "authorized_official_credential": "PT, DPT, CMFT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MD",
            "license": "26474",
            "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 Aug 10, 2017; 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.