Provider Demographics
NPI:1174894562
Name:EARTH ANGELS INC. OUTPATIENT REHAB
Entity type:Organization
Organization Name:EARTH ANGELS INC. OUTPATIENT REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-213-9925
Mailing Address - Street 1:2602 SOMERTON CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2981
Mailing Address - Country:US
Mailing Address - Phone:301-213-9925
Mailing Address - Fax:301-883-8414
Practice Address - Street 1:2602 SOMERTON CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2981
Practice Address - Country:US
Practice Address - Phone:301-213-9925
Practice Address - Fax:301-883-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2020-01-23
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