Healthcare Provider Details

I. General information

NPI: 1346605474
Provider Name (Legal Business Name): BAKER REHAB AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 08/18/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 THOMAS JOHNSON DR STE B
FREDERICK MD
21702-4314
US

IV. Provider business mailing address

197 THOMAS JOHNSON DR SUITE B
FREDERICK MD
21702-4314
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-1997
  • Fax:
Mailing address:
  • Phone: 301-662-1997
  • Fax: 301-668-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRANDON BAKER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 240-617-0786