MEDICARE: MARYLAND SPORTSCARE & REHAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1134077068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYLAND SPORTSCARE & REHAB LLC

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:	630-928-5080

Provider Business Practice Location Address
First Line	:	1013 BAY RIDGE AVE STE 410
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-3031
Country	:	US
Telephone Number	:	443-221-7743
Fax Number	:	443-221-7745

Authorized Official
Title or Position	:	DIRECTOR, CREDENTIALING
Name	:	JUANA GRANADOS
Credential	:
Telephone Number	:	630-575-1980

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “MARYLAND SPORTSCARE & REHAB LLC ” Practice Location

Language	Start Address	Practice Location

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