Healthcare Provider Details

I. General information

NPI: 1609249689
Provider Name (Legal Business Name): SELECT REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 STUART LN
CLINTON MD
20735-2712
US

IV. Provider business mailing address

8103 MAXFIELD DR
CLINTON MD
20735-2262
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-3600
  • Fax: 240-318-2350
Mailing address:
  • Phone: 301-742-8863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number18665
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number18665
License Number StateMD

VIII. Authorized Official

Name: MS. DEBORAH FISK FLETCHER
Title or Position: STAFF PHYSICAL THERAPIST
Credential: PT
Phone: 301-868-3600