=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629946678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEADBETTER REHABILITATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2025
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8927 FINGERBOARD RD STE A
-----------------------------------------------------
City | URBANA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21704-8164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-651-0149
-----------------------------------------------------
Fax | 240-559-2624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8420 GAS HOUSE PIKE STE U
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701-4974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-651-0149
-----------------------------------------------------
Fax | 240-559-2624
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | ROBERTA BRADLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-651-0149
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------