Provider Demographics
NPI:1457982217
Name:TITAN REHAB SERVICES
Entity Type:Organization
Organization Name:TITAN REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AFOLABI
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNNUSI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:443-985-7208
Mailing Address - Street 1:6340 SECURITY BLVD STE 100-B8
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5173
Mailing Address - Country:US
Mailing Address - Phone:443-985-7208
Mailing Address - Fax:
Practice Address - Street 1:6340 SECURITY BLVD STE 100-B8
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-5173
Practice Address - Country:US
Practice Address - Phone:443-985-7208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty