Provider Demographics
NPI:1801046172
Name:REHABILITATION OF FREDERICK
Entity Type:Organization
Organization Name:REHABILITATION OF FREDERICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:V
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:301-982-9110
Mailing Address - Street 1:85 THOMAS JOHNSON CT STE C
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4331
Mailing Address - Country:US
Mailing Address - Phone:301-682-9110
Mailing Address - Fax:
Practice Address - Street 1:85 THOMAS JOHNSON CT STE C
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4331
Practice Address - Country:US
Practice Address - Phone:301-682-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04628261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation