Healthcare Provider Details

I. General information

NPI: 1174894562
Provider Name (Legal Business Name): EARTH ANGELS INC. OUTPATIENT REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 SOMERTON CT
BOWIE MD
20721-2981
US

IV. Provider business mailing address

2602 SOMERTON CT
BOWIE MD
20721-2981
US

V. Phone/Fax

Practice location:
  • Phone: 301-213-9925
  • Fax: 301-883-8414
Mailing address:
  • Phone: 301-213-9925
  • Fax: 301-883-8414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. RITA EZE
Title or Position: OWNER/ CEO
Credential:
Phone: 301-213-9925