Provider Demographics
NPI:1750502167
Name:PROFESSIONAL REHAB GROUP
Entity Type:Organization
Organization Name:PROFESSIONAL REHAB GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:GORDONLARSON
Authorized Official - Last Name:WARFEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-245-5030
Mailing Address - Street 1:2601 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21161-9743
Mailing Address - Country:US
Mailing Address - Phone:410-245-5030
Mailing Address - Fax:
Practice Address - Street 1:2601 GARRETT RD
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:MD
Practice Address - Zip Code:21161-9743
Practice Address - Country:US
Practice Address - Phone:410-245-5030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty