Provider Demographics
NPI:1518107903
Name:REHABIT SMARTCENTER, LLC
Entity Type:Organization
Organization Name:REHABIT SMARTCENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-537-7862
Mailing Address - Street 1:2814 HATBORO PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9400
Mailing Address - Country:US
Mailing Address - Phone:301-537-7862
Mailing Address - Fax:240-245-4212
Practice Address - Street 1:12150 ANNAPOLIS RD
Practice Address - Street 2:SUITE 211
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9179
Practice Address - Country:US
Practice Address - Phone:240-245-4211
Practice Address - Fax:240-245-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00464762081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00347Medicare UPIN