Provider Demographics
NPI:1861851164
Name:LIFESPAN REHAB LLC.
Entity Type:Organization
Organization Name:LIFESPAN REHAB LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:RAUSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:443-879-9495
Mailing Address - Street 1:316 GERMAN HILL RD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1514
Mailing Address - Country:US
Mailing Address - Phone:443-879-9495
Mailing Address - Fax:
Practice Address - Street 1:316 GERMAN HILL RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1514
Practice Address - Country:US
Practice Address - Phone:443-879-9495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20389261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy