Provider Demographics
NPI:1871961300
Name:REHABILITATON SERVICES OF GREATER WASHINGTON LLC
Entity type:Organization
Organization Name:REHABILITATON SERVICES OF GREATER WASHINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:OT/CHT
Authorized Official - Phone:301-881-4610
Mailing Address - Street 1:3200 TOWER OAKS BLVD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4216
Mailing Address - Country:US
Mailing Address - Phone:301-881-4610
Mailing Address - Fax:301-881-4612
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-592-0026
Practice Address - Fax:301-592-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20849225100000X
MD22635225100000X
MD01884225XH1200X
MD01450225XH1200X
MD06977225XH1200X
MD07005225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00315Medicare UPIN