1184627622 NPI number — REHABILITATION PRACTITIONERS INC

Table of content: (NPI 1184627622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184627622 NPI number — REHABILITATION PRACTITIONERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION PRACTITIONERS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184627622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 W CORK ST
Provider Second Line Business Mailing Address:
UNIT 30
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-722-9025
Provider Business Mailing Address Fax Number:
540-667-9915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 E ANTIETAM ST
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-5768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-739-5060
Provider Business Practice Location Address Fax Number:
540-667-9915
Provider Enumeration Date:
05/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CESTARO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
540-722-9025

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 095098000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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