Provider Demographics
NPI:1487806386
Name:AFFINITY REHABILITATIVE THERAPY, L.L.C
Entity type:Organization
Organization Name:AFFINITY REHABILITATIVE THERAPY, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, PT
Authorized Official - Phone:301-367-7797
Mailing Address - Street 1:7501 GREENWAY CENTER DRIVE SUITE 800
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3514
Mailing Address - Country:US
Mailing Address - Phone:301-220-3009
Mailing Address - Fax:301-220-2373
Practice Address - Street 1:7501 GREENWAY CENTER DR STE 800
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3554
Practice Address - Country:US
Practice Address - Phone:301-220-3009
Practice Address - Fax:301-220-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty