Basic Information
| Provider Information | |||||||||
| NPI: | 1396176426 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONAL REHABILIATION HOSPITAL, INC | ||||||||
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| OtherOrganizationName: | MEDSTAR NRH AT LAKE RIDGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20410 CENTURY BLVD STE 215 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208741187 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12825 MINNIEVILLE RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221923601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039713701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2013 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | BRICKLEY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT AMBULATORY OPERATION | ||||||||
| AuthorizedOfficialTelephone: | 3015406140 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NATIONAL REHABILITATION, INC | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.