Provider Demographics
NPI:1699259382
Name:FLAGSHIP REHABILITATION, INC
Entity type:Organization
Organization Name:FLAGSHIP REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CORPORATE COMPLIANCE/QI
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:PUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-722-3215
Mailing Address - Street 1:157 BALTIMORE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2472
Mailing Address - Country:US
Mailing Address - Phone:301-722-3215
Mailing Address - Fax:301-722-1028
Practice Address - Street 1:12185 CLIPPER DR
Practice Address - Street 2:
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2236
Practice Address - Country:US
Practice Address - Phone:703-496-3486
Practice Address - Fax:703-496-3487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000000004OtherCOMMERCIAL