Provider Demographics
NPI:1043562051
Name:SOUTH MOUNTAIN REHABILITATION INC
Entity Type:Organization
Organization Name:SOUTH MOUNTAIN REHABILITATION INC
Other - Org Name:MCQUARRIES PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCQUARRIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:240-818-8630
Mailing Address - Street 1:9722 MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-9523
Mailing Address - Country:US
Mailing Address - Phone:240-818-8630
Mailing Address - Fax:240-356-0340
Practice Address - Street 1:4707 SCHLEY AVE # F
Practice Address - Street 2:STE 595
Practice Address - City:BRADDOCK HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:21714-7500
Practice Address - Country:US
Practice Address - Phone:240-356-0330
Practice Address - Fax:240-356-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy