NPIMap

Organization Active NPI

Physical & Sports Rehab Inc

  • Physical Therapist
  • Largo, MD
National Provider Identifier
1811271968
Registry record updated Mar 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PHYSICAL & SPORTS REHAB INC
Practice address
1401 Mercantile LN
Suite 107
Largo, MD 20774-4301
Phone
(301) 658-6881
Fax
(301) 322-2563
NPI assigned
Oct 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paul Anthony Heath, PTNPI 1861600967
Title
Founder & Executive Director
Phone
(301) 658-6881

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1401 Mercantile LN
Suite 107
Largo, MD 20774-4301

Mailing address

1401 Mercantile LN
Suite 107
Largo, MD 20774-4301
Phone (301) 658-6881

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120131000695 DC Part B Supplier - Clinic/Group Practice 2860659026 Receives reassigned benefits from 4 practitioners
Practice locations: Upper Marlboro, MD

National Provider Directory

National Provider Directory

Locations

1401 Mercantile Ln
Ste 107
Uppr Marlboro, MD 20774
Phone (301) 658-6881

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332720000000",
    "number": "1811271968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 MERCANTILE LN",
            "address_2": "SUITE 107",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207744301",
            "telephone_number": "301-658-6881",
            "fax_number": "301-322-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MERCANTILE LN",
            "address_2": "SUITE 107",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207744301",
            "telephone_number": "301-658-6881",
            "fax_number": "301-322-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL & SPORTS REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-07",
        "last_updated": "2012-03-26",
        "status": "A",
        "authorized_official_last_name": "HEATH",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "FOUNDER & EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "301-658-6881",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.