Healthcare Provider Details

I. General information

NPI: 1750734299
Provider Name (Legal Business Name): LEADBETTER REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 GAS HOUSE PIKE SUITE U
FREDERICK MD
21701-4971
US

IV. Provider business mailing address

8420 GAS HOUSE PIKE SUITE U
FREDERICK MD
21701-4971
US

V. Phone/Fax

Practice location:
  • Phone: 240-651-0149
  • Fax: 240-559-2624
Mailing address:
  • Phone: 443-414-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20003
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBERTA BRADLE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 240-651-0149