NPIMap

Organization Active NPI

Evidence Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Glenn Dale, MD
National Provider Identifier
1831493030
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
EVIDENCE PHYSICAL THERAPY, LLC
Practice address
12150 Annapolis Rd Ste 201
Glenn Dale, MD 20769
Phone
(301) 352-8370
Fax
(301) 352-8372
NPI assigned
Jan 3, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

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

Authorized official

Name
Mrs. Hassana Moses, SHRM-CP
Title
Practice Administrator
Phone
(301) 352-8370

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251X0800X 21846 MD
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

12150 Annapolis Rd Ste 201
Glenn Dale, MD 20769

Mailing address

12150 Annapolis Rd
Suite 201
Glenn Dale, MD 20769-9183
Phone (301) 352-8370

Other practice location 1

7801 Old Branch Ave Ste 105
Clinton, MD 20735-1641
Phone (301) 856-8386

Other identifiers 2

IdentifierTypeStateIssuer
616235300OtherWORKERS COMPENSATION NUMBER
045308100MedicaidMD

Other names 1

  • EvidencePT Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110524000765 DC Part B Supplier - Clinic/Group Practice 3779769971 Receives reassigned benefits from 18 practitioners
Practice locations: Clinton, MD; Glenn Dale, MD; Laurel, MD
O20250725003138 MD DME Supplier - Independently-Practicing Physical Therapist 3779769971 Practice locations: Glenn Dale, MD

National Provider Directory

National Provider Directory
Tax ID family
Evidence Physical Therapy LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

12150 Annapolis Rd
Ste 204
Glenn Dale, MD 20769
Phone (301) 352-8370

14501 Baltimore Ave
Laurel, MD 20707
Phone (301) 799-9466

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1294012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1831493030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12150 ANNAPOLIS RD",
            "address_2": "SUITE 201",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699183",
            "telephone_number": "301-352-8370",
            "fax_number": "301-352-8372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12150 ANNAPOLIS RD STE 201",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "20769",
            "telephone_number": "301-352-8370",
            "fax_number": "301-352-8372"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7801 Old Branch Ave Ste 105",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "MD",
            "postal_code": "207351641",
            "country_code": "US",
            "telephone_number": "301-856-8386",
            "fax_number": "301-356-8389",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVIDENCE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-03",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A",
        "authorized_official_last_name": "MOSES",
        "authorized_official_first_name": "HASSANA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "301-352-8370",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "SHRM-CP"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MD",
            "license": "21846",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION NUMBER",
            "identifier": "616235300",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "045308100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EvidencePT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EvidencePT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glenn Dale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; 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.