Provider Demographics
NPI:1811271968
Name:PHYSICAL & SPORTS REHAB INC
Entity type:Organization
Organization Name:PHYSICAL & SPORTS REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-658-6881
Mailing Address - Street 1:1401 MERCANTILE LN
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4301
Mailing Address - Country:US
Mailing Address - Phone:301-658-6881
Mailing Address - Fax:301-322-2563
Practice Address - Street 1:1401 MERCANTILE LN
Practice Address - Street 2:SUITE 107
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4301
Practice Address - Country:US
Practice Address - Phone:301-658-6881
Practice Address - Fax:301-322-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty