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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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical Therapist
4261Q00000XClinic/Center

General Provider Information

NPI Number : 1962350421
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 :
Provider Business Practice Location Address
First Line : 8890 CENTRE PARK DR STE 400
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-2170
Country : US
Telephone Number : 410-884-6000
Fax Number : 410-884-9990
Authorized Official
Title or Position : DIRECTOR, CREDENTIALING
Name : JUANA GRANADOS
Credential :
Telephone Number : 630-575-1980
Provider Enumeration Date : 03/19/2026
Last Update Date : 03/19/2026

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Directions to “MARYLAND SPORTSCARE & REHAB LLC ” Practice Location

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