NPIMap

Organization Active NPI

Physical Therapy and Pain Management Center LLC

Doing business as College Park Physical Therapy & Hand Rehabilitation

  • Rehabilitation Clinic/Center
  • Riverdale Park, MD
National Provider Identifier
1982337424
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PHYSICAL THERAPY AND PAIN MANAGEMENT CENTER LLC
Doing business as
College Park Physical Therapy & Hand Rehabilitation
Practice address
4595 Van Buren St Ste 210
Riverdale Park, MD 20737-1080
Phone
(301) 864-0009
Fax
(301) 864-0012
NPI assigned
Jul 1, 2022
Last updated
Jan 30, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PHYSICAL THERAPY AND PAIN MANAGEMENT CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Authorized official

Name
Mr. David Michael Bullock, P.T.NPI 1447322482
Title
Founder
Phone
(301) 592-8200

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Rehabilitation Clinic/Center 261QR0400X NU Primary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Customized Equipment (DME) 332BC3200X NU

Addresses

Primary practice location

4595 Van Buren St Ste 210
Riverdale Park, MD 20737-1080

Mailing address

4595 Van Buren St Ste 210
Riverdale Park, MD 20737-1080
Phone (301) 864-0009

Other names 1

  • College Park Physical Therapy & Hand Rehabilitation Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Physical Therapy and Pain Management Center LLC3 organizations share this tax ID, including this one
Part of
Physical Therapy and Pain Management Center LLC

Other organizations with this tax ID 2

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

Locations

4595 Van Buren St
#210
Riverdale Pk, MD 20737
Phone (301) 864-0009

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1656633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1982337424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4595 VAN BUREN ST STE 210",
            "city": "RIVERDALE PARK",
            "state": "MD",
            "postal_code": "207371080",
            "telephone_number": "301-864-0009",
            "fax_number": "301-864-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4595 VAN BUREN ST STE 210",
            "city": "RIVERDALE PARK",
            "state": "MD",
            "postal_code": "207371080",
            "telephone_number": "301-864-0009",
            "fax_number": "301-864-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY AND PAIN MANAGEMENT CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHYSICAL THERAPY AND PAIN MANAGEMENT CENTER LLC",
        "enumeration_date": "2022-07-01",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "301-592-8200",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "College Park Physical Therapy & Hand Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "College Park Physical Therapy & Hand Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverdale Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.