Provider Demographics
NPI:1649290164
Name:REHAB SPECIALISTS OF FREDERICK, LLC
Entity type:Organization
Organization Name:REHAB SPECIALISTS OF FREDERICK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:301-722-3215
Mailing Address - Street 1:157 BALTIMORE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2319
Mailing Address - Country:US
Mailing Address - Phone:301-722-3215
Mailing Address - Fax:
Practice Address - Street 1:65 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE D
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4371
Practice Address - Country:US
Practice Address - Phone:301-663-7898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD635MMedicare PIN