Provider Demographics
NPI:1750507612
Name:ADVANCED REHAB ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ADVANCED REHAB ASSOCIATES, LLC
Other - Org Name:ADVANCED REHAB PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-386-6116
Mailing Address - Street 1:826 WASHINGTON ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6003
Mailing Address - Country:US
Mailing Address - Phone:410-386-6116
Mailing Address - Fax:410-386-0800
Practice Address - Street 1:826 WASHINGTON ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6003
Practice Address - Country:US
Practice Address - Phone:410-386-6116
Practice Address - Fax:410-386-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
532MMedicare ID - Type Unspecified