Healthcare Provider Details

I. General information

NPI: 1609580281
Provider Name (Legal Business Name): WONDAFRASH REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 QUEENS CHAPEL RD
HYATTSVILLE MD
20782-3867
US

IV. Provider business mailing address

306 W REDWOOD ST STE 200
BALTIMORE MD
21201-1708
US

V. Phone/Fax

Practice location:
  • Phone: 301-277-6500
  • Fax:
Mailing address:
  • Phone: 215-432-6315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCUS TESHOME
Title or Position: OWNER
Credential:
Phone: 215-432-6315