Provider Demographics
NPI:1003855461
Name:ATLANTIC REHAB, INC
Entity Type:Organization
Organization Name:ATLANTIC REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELCH
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, MS, JSCC
Authorized Official - Phone:410-768-9500
Mailing Address - Street 1:5 CRAIN HWY N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2803
Mailing Address - Country:US
Mailing Address - Phone:410-768-9500
Mailing Address - Fax:410-768-5200
Practice Address - Street 1:5 CRAIN HWY N
Practice Address - Street 2:SUITE 103
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2803
Practice Address - Country:US
Practice Address - Phone:410-768-9500
Practice Address - Fax:410-768-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1924261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD072MMedicare ID - Type Unspecified