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Organization
MARYLAND REHAB, LLC
Active
Organization
MARYLAND REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMED S MANSOUR DPT (OWNER)
(301) 957-1237
Entity
Organization
Contact information
Practice address
13500 GAMBREL CT, LAUREL, MD 20708-1389
(301) 617-2773
(240) 334-4824
Mailing address
13500 GAMBREL CT, LAUREL, MD 20708-1389
(301) 617-2773
(240) 334-4824
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
23820
MD
225100000X
Physical Therapist
Primary
PT870480
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23820
MARYLAND BOARD OF PHYSICAL THERAPY
MD
01
—
PT870480
DC DEPARTMENT OF HEALTH
DC
Enumeration date
12/06/2014
Last updated
12/31/2014
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