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General NPI Number Information
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NPI Number | 1881911584
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Entity Type | Organization
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Legal Business Name | CAPITOL REHAB OF CROFTON INC
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 1625 CROFTON CTR
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City | CROFTON
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State | MD
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Zip | 21114-1318
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Country | US
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Telephone | 410-451-3561
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Fax | 410-451-2265
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Provider Business Mailing Address
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Address Line | 1625 CROFTON CTR
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City | CROFTON
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State | MD
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Zip | 21114-1318
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Country | US
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Telephone | 410-451-3561
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Fax | 410-451-2265
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Authorized Official
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Title or Position | OWNER/DR.
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Name | DR. SHAUN R MCCLENNY
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Credential | D.C.
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Telephone | 410-451-3561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 03452
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License Number State | MD
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