Healthcare Provider Details

I. General information

NPI: 1841630449
Provider Name (Legal Business Name): MAGNOLIA REHABILITATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 UNDERPASS WAY STE 201
HAGERSTOWN MD
21740-6968
US

IV. Provider business mailing address

1710 UNDERPASS WAY STE 201
HAGERSTOWN MD
21740-6968
US

V. Phone/Fax

Practice location:
  • Phone: 301-745-8700
  • Fax:
Mailing address:
  • Phone: 301-745-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
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: JOHN PERINI
Title or Position: PRESIDENT
Credential:
Phone: 301-745-8700