Provider Demographics
NPI:1447771431
Name:MID-ATLANTIC BRAIN & NEUROLOGICAL REHABILITATION, INC.
Entity Type:Organization
Organization Name:MID-ATLANTIC BRAIN & NEUROLOGICAL REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRICE
Authorized Official - Middle Name:SPRINGER
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-249-7462
Mailing Address - Street 1:1400 FOREST GLEN RD STE 225
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1459
Mailing Address - Country:US
Mailing Address - Phone:240-766-8881
Mailing Address - Fax:240-766-3763
Practice Address - Street 1:1400 FOREST GLEN RD STE 225
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1459
Practice Address - Country:US
Practice Address - Phone:240-766-8881
Practice Address - Fax:240-766-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06275225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty