Healthcare Provider Details

I. General information

NPI: 1811429384
Provider Name (Legal Business Name): ASBURY ATLANTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 ASBURY CIR
SOLOMONS MD
20688-3004
US

IV. Provider business mailing address

11100 ASBURY CIR
SOLOMONS MD
20688-3004
US

V. Phone/Fax

Practice location:
  • Phone: 410-394-3000
  • Fax: 410-394-3008
Mailing address:
  • Phone: 410-394-3000
  • Fax: 410-394-3008

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: MR. BRAD ANDRUS
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A., M.A.G.S
Phone: 410-394-3030