Provider Demographics
NPI:1053319491
Name:PEAK REHAB, INC.
Entity Type:Organization
Organization Name:PEAK REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD CCC SLP
Authorized Official - Phone:301-533-1010
Mailing Address - Street 1:1477 MARYLAND HWY
Mailing Address - Street 2:
Mailing Address - City:MT LAKE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21550-6346
Mailing Address - Country:US
Mailing Address - Phone:301-533-1010
Mailing Address - Fax:301-334-3059
Practice Address - Street 1:1477 MARYLAND HWY
Practice Address - Street 2:
Practice Address - City:MT LAKE PARK
Practice Address - State:MD
Practice Address - Zip Code:21550-6346
Practice Address - Country:US
Practice Address - Phone:301-533-1010
Practice Address - Fax:301-334-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD263871OtherMAMSI
MDJ980OtherFED CARE FIRST
MD43350OtherIWIF
MDKBA5PEOtherCAREFIRST
WV0204985000Medicaid
MD43350OtherIWIF
WV0204985000Medicaid