Healthcare Provider Details

I. General information

NPI: 1609382837
Provider Name (Legal Business Name): MARYLAND SPORTSCARE & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19785 CRYSTAL ROCK DR STE 311
GERMANTOWN MD
20874-4732
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 301-540-3529
  • Fax:
Mailing address:
  • Phone: 252-248-3313
  • Fax: 410-648-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JUANA GRANADOS
Title or Position: DIRECTOR, CREDENTIALING
Credential:
Phone: 630-575-1980