MEDICARE: CORE CONCEPTS PHYSICAL THERAPY AND PILATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	22720	MD

General Provider Information

NPI Number	:	1043696123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE CONCEPTS PHYSICAL THERAPY AND PILATES

Provider Business Mailing Address
First Line	:	41 MAGNA WAY
Second Line	:	SUITE 140
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-3073
Country	:	US
Telephone Number	:	443-487-6614
Fax Number	:	443-487-6613

Provider Business Practice Location Address
First Line	:	41 MAGNA WAY
Second Line	:	SUITE 140
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-3073
Country	:	US
Telephone Number	:	443-487-6614
Fax Number	:	443-487-6613

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	DR. ANDREA EISGRUBER
Credential	:	DPT
Telephone Number	:	443-487-6614

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	01/05/2017

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