Provider Demographics
NPI:1104037852
Name:GREENBELT REHAB
Entity Type:Organization
Organization Name:GREENBELT REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:CRIVELLI
Authorized Official - Suffix:II
Authorized Official - Credentials:DC, MS, CNS
Authorized Official - Phone:301-474-5505
Mailing Address - Street 1:8713 GREENBELT RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2481
Mailing Address - Country:US
Mailing Address - Phone:301-474-5505
Mailing Address - Fax:301-474-5505
Practice Address - Street 1:8713 GREENBELT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2481
Practice Address - Country:US
Practice Address - Phone:301-474-5505
Practice Address - Fax:301-474-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02085-PT111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00982Medicare ID - Type Unspecified