Healthcare Provider Details

I. General information

NPI: 1710411558
Provider Name (Legal Business Name): INNOVATIVE PHYSICAL THERAPY AND FITNESS CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WALTER WARD BLVD UNIT 200
ABINGDON MD
21009
US

IV. Provider business mailing address

9526 PHILADELPHIA RD
ROSEDALE MD
21237-4106
US

V. Phone/Fax

Practice location:
  • Phone: 302-528-4019
  • Fax: 443-327-5282
Mailing address:
  • Phone: 443-512-8337
  • Fax: 443-327-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number23639
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRYAN MORROW
Title or Position: CEO
Credential: MSPT
Phone: 302-528-4019