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General NPI Number Information
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NPI Number | 1639733348
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Entity Type | Organization
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Legal Business Name | HYATTSVILLE REHAB CENTER, LLC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 7411 RIGGS RD STE 219
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City | ADELPHI
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State | MD
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Zip | 20783-4246
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Country | US
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Telephone | 703-214-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 7411 RIGGS RD STE 219
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City | ADELPHI
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State | MD
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Zip | 20783-4246
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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 | OWNER
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Name | SU MIN KO
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Credential | MD
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Telephone | 703-214-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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