Healthcare Provider Details

I. General information

NPI: 1225572753
Provider Name (Legal Business Name): TANDEM REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 BRIGADE CIR
FREDERICK MD
21702-2514
US

IV. Provider business mailing address

2127 BRIGADE CIR
FREDERICK MD
21702-2514
US

V. Phone/Fax

Practice location:
  • Phone: 757-218-9831
  • Fax:
Mailing address:
  • Phone: 757-218-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number24046
License Number StateMD

VIII. Authorized Official

Name: MS. SAMIAT B TUMASANG
Title or Position: CEO / OWNER
Credential: DPT
Phone: 757-218-9831