Provider Demographics
NPI:1750734299
Name:LEADBETTER REHABILITATION, LLC
Entity type:Organization
Organization Name:LEADBETTER REHABILITATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-651-0149
Mailing Address - Street 1:8420 GAS HOUSE PIKE
Mailing Address - Street 2:SUITE U
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4971
Mailing Address - Country:US
Mailing Address - Phone:443-414-9888
Mailing Address - Fax:
Practice Address - Street 1:8420 GAS HOUSE PIKE
Practice Address - Street 2:SUITE U
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4971
Practice Address - Country:US
Practice Address - Phone:443-414-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04905225XH1200X
MD20003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty