Basic Information
| Provider Information | |||||||||
| NPI: | 1548323736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOPINATHAN | ||||||||
| FirstName: | REENA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 WAYNE AVENUE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016500036 | ||||||||
| FaxNumber: | 3016500038 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 WAYNE AVENUE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016500036 | ||||||||
| FaxNumber: | 3016500038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 12/02/2010 | ||||||||
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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 | PT870644 | DC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 21673 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.