Healthcare Provider Details

I. General information

NPI: 1225417371
Provider Name (Legal Business Name): CAPITAL REHABILITATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9047 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

IV. Provider business mailing address

9047 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

V. Phone/Fax

Practice location:
  • Phone: 240-477-7207
  • Fax: 240-477-7527
Mailing address:
  • Phone: 240-477-7207
  • Fax: 240-477-7527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23559
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number05279
License Number StateMD

VIII. Authorized Official

Name: MICHAEL FELISILDA
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 706-897-5835