Provider Demographics
NPI:1750379905
Name:HARRIS AND DEFLORA REHABILITATION INC
Entity type:Organization
Organization Name:HARRIS AND DEFLORA REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-391-4300
Mailing Address - Street 1:8202 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2825
Mailing Address - Country:US
Mailing Address - Phone:410-391-4300
Mailing Address - Fax:410-391-4453
Practice Address - Street 1:8202 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-2825
Practice Address - Country:US
Practice Address - Phone:410-391-4300
Practice Address - Fax:410-391-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10800225100000X
MD11350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD228588600Medicaid
MDK098OtherBCBS
WAK076OtherBCBS
MD216565Medicare ID - Type Unspecified