Healthcare Provider Details

I. General information

NPI: 1134105273
Provider Name (Legal Business Name): USA REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CHURCH LN # 107
BALTIMORE MD
21208-3786
US

IV. Provider business mailing address

104 CHURCH LN # 107
BALTIMORE MD
21208-3786
US

V. Phone/Fax

Practice location:
  • Phone: 410-653-3903
  • Fax:
Mailing address:
  • Phone: 410-653-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC ANDERSON
Title or Position: OWNER
Credential:
Phone: 410-653-3903