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General NPI Number Information
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NPI Number | 1235516956
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Entity Type | Organization
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Legal Business Name | NRH/CPT/ST.MARY/CIVISTA REGIONAL REHABILITATION, INC.
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 3 POST OFFICE RD SUITE 105
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City | WALDORF
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State | MD
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Zip | 20602-2756
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Country | US
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Telephone | 301-373-2588
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Fax |
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Provider Business Mailing Address
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Address Line | 20410 CENTURY BLVD SUITE 215
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City | GERMANTOWN
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State | MD
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Zip | 20874-1186
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT AMBULATORY OPERATION
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Name | JOHN BRICKLEY
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Credential |
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Telephone | 301-540-6140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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