Basic Information
| Provider Information | |||||||||
| NPI: | 1235249962 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONCEPCION | ||||||||
| FirstName: | DONNA | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8926 WOODYARD RD | ||||||||
| Address2: | SUITE 701 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207354220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018561682 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11325 PEMBROOKE SQ | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206034807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016385313 | ||||||||
| FaxNumber: | 3016385343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 01/20/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 168919ZAKW | 01 | MARYLAND MEDICARE | OTHER | 46950040 | 01 | CAREFIRST NCA | OTHER | 21516 | 01 | MD | LICENSE # | OTHER | 64731703 | 01 | CAREFIRST OF MARYLAND | OTHER |