Healthcare Provider Details

I. General information

NPI: 1568849958
Provider Name (Legal Business Name): HEALTHPRO REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 PENHURST AVE
BALTIMORE MA
21215
US

IV. Provider business mailing address

3939 PENHURST AVE
BALTIMORE MD
21215-5632
US

V. Phone/Fax

Practice location:
  • Phone: 443-525-7577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number25061
License Number StateMD

VIII. Authorized Official

Name: DR. XUAN ZHAO
Title or Position: REHABILITATION DIRECTOR
Credential: DPT
Phone: 443-525-7577