Healthcare Provider Details

I. General information

NPI: 1558086587
Provider Name (Legal Business Name): ASBURY ATLANTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RUSSELL AVE
GAITHERSBURG MD
20877-2807
US

IV. Provider business mailing address

5285 WESTVIEW DR STE 200
FREDERICK MD
21703-8521
US

V. Phone/Fax

Practice location:
  • Phone: 301-250-2105
  • Fax:
Mailing address:
  • Phone: 301-250-2105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MAGDALENE OLSEN
Title or Position: LEGAL & COMPLIANCE PROGRAM COORD.
Credential:
Phone: 301-250-2105