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NPI Code Detail

MEDICARE: MARYLAND SPORTSCARE & REHAB, LLC

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 License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1316304751
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 : 252-248-3313
Fax Number : 410-648-4878
Provider Business Practice Location Address
First Line : 9815 MAIN ST
Second Line : STE 206
City : DAMASCUS
State : MD
Zip : 20872-2002
Country : US
Telephone Number : 301-253-6761
Fax Number : 301-253-6762
Authorized Official
Title or Position : MANAGER, CREDENTIALING
Name : TASHEDA BROUGHTON
Credential : PESC
Telephone Number : 252-248-3313
Provider Enumeration Date : 01/15/2016
Last Update Date : 10/23/2024

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Directions to “MARYLAND SPORTSCARE & REHAB, LLC ” Practice Location

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