Provider Demographics
NPI:1629434675
Name:SELECT MEDICAL
Entity Type:Organization
Organization Name:SELECT MEDICAL
Other - Org Name:NOVA CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PSS
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAINU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-986-9252
Mailing Address - Street 1:3 BETHESDA METRO CTR
Mailing Address - Street 2:B0001
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5330
Mailing Address - Country:US
Mailing Address - Phone:301-986-9252
Mailing Address - Fax:301-718-6152
Practice Address - Street 1:3 BETHESDA METRO CTR
Practice Address - Street 2:B0001
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5330
Practice Address - Country:US
Practice Address - Phone:301-986-9252
Practice Address - Fax:301-718-6152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELECTMEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy