Provider Demographics
NPI:1366996761
Name:INNERLINKS PHYSICAL THERAPY AND WELLNESS, LLC
Entity type:Organization
Organization Name:INNERLINKS PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-706-0688
Mailing Address - Street 1:3 EXECUTIVE PARK CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2643
Mailing Address - Country:US
Mailing Address - Phone:301-706-0688
Mailing Address - Fax:301-515-6039
Practice Address - Street 1:3 EXECUTIVE PARK CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2643
Practice Address - Country:US
Practice Address - Phone:301-706-0688
Practice Address - Fax:301-515-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16448261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy