Provider Demographics
NPI:1649291840
Name:AFFINITY SPORTS & REHABILITATION
Entity type:Organization
Organization Name:AFFINITY SPORTS & REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:BAKER-HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-562-1116
Mailing Address - Street 1:1105 SPRING STREET
Mailing Address - Street 2:STE H
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4030
Mailing Address - Country:US
Mailing Address - Phone:301-562-1116
Mailing Address - Fax:301-562-1317
Practice Address - Street 1:1105 SPRING STREET
Practice Address - Street 2:STE H
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4030
Practice Address - Country:US
Practice Address - Phone:301-562-1116
Practice Address - Fax:301-562-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18131225100000X
MD20689225100000X
MD18677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00193Medicare ID - Type Unspecified