Healthcare Provider Details

I. General information

NPI: 1508335175
Provider Name (Legal Business Name): METRO HEALTH AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 ATTERBURY PL
FREDERICK MD
21704-7401
US

IV. Provider business mailing address

4070 ATTERBURY PL
FREDERICK MD
21704-7401
US

V. Phone/Fax

Practice location:
  • Phone: 240-409-9611
  • Fax:
Mailing address:
  • Phone: 240-409-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DANAH D JACK
Title or Position: PRINCIPAL
Credential:
Phone: 240-409-9611