Provider Demographics
NPI:1952158917
Name:EXCELLENT PHYSICAL REHABILITATION NETWORK, LLC
Entity Type:Organization
Organization Name:EXCELLENT PHYSICAL REHABILITATION NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REY FELIX
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUGASH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:240-507-0114
Mailing Address - Street 1:2722 SILVER HAMMER WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-3243
Mailing Address - Country:US
Mailing Address - Phone:240-507-0114
Mailing Address - Fax:
Practice Address - Street 1:2722 SILVER HAMMER WAY
Practice Address - Street 2:
Practice Address - City:BROOKEVILLE
Practice Address - State:MD
Practice Address - Zip Code:20833-3243
Practice Address - Country:US
Practice Address - Phone:240-507-0114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy