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PHOENIX REHABILITATION AND HEALTH SERVICES, LLC
Complete NPI Record 1558992404
Physical Therapist in Columbia, MD

NPI Status: Active since January 30, 2020

Contact Information

6410 DOBBIN RD STE G
COLUMBIA, MD
ZIP 21045
Phone: (443) 917-2951
Fax: (443) 864-5296

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Is Organization Subpart
  30. Parent Organization LBN
  31. Parent Organization TIN
  32. Healthcare Provider Taxonomy Group 1
  33. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1558992404. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1558992404
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Other Organization Name: PHOENIX REHABILITATION AND HEALTH SERVICES, LLC
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: PO BOX 392573
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider Business Mailing Address City Name: PITTSBURGH
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: PA
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address Postal Code: 152519573
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Telephone Number: 7243434060
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 7243434069
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 6410 DOBBIN RD STE G
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: COLUMBIA
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address State Name: MD
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 210454774
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number: 4439172951
The fax number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 4438645296
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 1/30/2020
The fax number associated with the location address of the provider being identified.
Last Update Date: 1/10/2022
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official Last Name: METAL-CONFER
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: BRENDA
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official Title or Position: SR CREDENTIALING
The 10-position telephone number of the authorized official.
Authorized Official Telephone Number: 7244482733
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 225100000X
The 10-position telephone number of the authorized official.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: Y
Parent Organization LBN: PHOENIX REHABILITATION AND HEALTH SERVICES, INC.
Parent Organization TIN: UNAVAIL
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 1/10/2022