Healthcare Provider Details

I. General information

NPI: 1033252184
Provider Name (Legal Business Name): TRI-STATE REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19733 LEITERSBURG PIKE STE 102
HAGERSTOWN MD
21742-1484
US

IV. Provider business mailing address

19737 LEITERSBURG PIKE SUITE B
HAGERSTOWN MD
21742-1443
US

V. Phone/Fax

Practice location:
  • Phone: 301-714-0700
  • Fax: 301-714-0703
Mailing address:
  • Phone: 240-420-0859
  • Fax: 240-420-0971

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: MRS. ELIZABETH S KENNEDY
Title or Position: ADMINSTRATIVE DIRECTOR
Credential:
Phone: 301-714-0700