Healthcare Provider Details

I. General information

NPI: 1841534468
Provider Name (Legal Business Name): VARSITY PROFESSIONAL REHABILITATION AND STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 JERICHO PARK ROAD
BOWIE MD
20715
US

IV. Provider business mailing address

PO BOX 1597
WASHINGTON DC
20013-1597
US

V. Phone/Fax

Practice location:
  • Phone: 202-277-7887
  • Fax:
Mailing address:
  • Phone: 202-277-7887
  • Fax: 240-419-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL OSEI MERRICK
Title or Position: CEO/PHYSICAL THERAPIST
Credential: DPT
Phone: 202-277-7887