Healthcare Provider Details

I. General information

NPI: 1639733348
Provider Name (Legal Business Name): HYATTSVILLE REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 RIGGS RD STE 219
ADELPHI MD
20783-4246
US

IV. Provider business mailing address

7411 RIGGS RD STE 219
ADELPHI MD
20783-4246
US

V. Phone/Fax

Practice location:
  • Phone: 703-214-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SU MIN KO
Title or Position: OWNER
Credential: MD
Phone: 703-214-1000