Provider Demographics
NPI:1033252184
Name:TRI-STATE REHAB INC
Entity Type:Organization
Organization Name:TRI-STATE REHAB INC
Other - Org Name:FYZICAL THERAPY AND BALANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-420-0859
Mailing Address - Street 1:19737 LEITERSBURG PIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1443
Mailing Address - Country:US
Mailing Address - Phone:240-420-0859
Mailing Address - Fax:240-420-0971
Practice Address - Street 1:188 EASTERN BLVD N
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5843
Practice Address - Country:US
Practice Address - Phone:301-714-0700
Practice Address - Fax:301-714-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD690700800Medicaid