Provider Demographics
NPI:1518950641
Name:GARRETT REHAB SERVICES, LLC
Entity Type:Organization
Organization Name:GARRETT REHAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-334-1863
Mailing Address - Street 1:6500 THAYER CTR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1116
Mailing Address - Country:US
Mailing Address - Phone:301-334-1863
Mailing Address - Fax:301-334-5835
Practice Address - Street 1:6500 THAYER CTR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1116
Practice Address - Country:US
Practice Address - Phone:301-334-1863
Practice Address - Fax:301-334-5835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225100000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1044470OtherWV WORKERS' COMPENSATION
MDKG97OtherCAREFIRST BCBS
MD186300200Medicaid
MD37456OtherIWIF
MDW281OtherFEDERAL BCBS
WV3810004255Medicaid
MD37456OtherIWIF