Healthcare Provider Details

I. General information

NPI: 1699259382
Provider Name (Legal Business Name): FLAGSHIP REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12185 CLIPPER DR
LAKE RIDGE VA
22192-2236
US

IV. Provider business mailing address

157 BALTIMORE ST STE 200
CUMBERLAND MD
21502-2472
US

V. Phone/Fax

Practice location:
  • Phone: 703-496-3486
  • Fax: 703-496-3487
Mailing address:
  • Phone: 301-722-3215
  • Fax: 301-722-1028

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. SHARON KATHLEEN PUSEY
Title or Position: VP CORPORATE COMPLIANCE/QI
Credential: RN
Phone: 301-722-3215