Healthcare Provider Details

I. General information

NPI: 1669917993
Provider Name (Legal Business Name): BACK TO FIT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MEDICAL PKWY 150
ANNAPOLIS MD
21401-3046
US

IV. Provider business mailing address

2002 MEDICAL PKWY 150
ANNAPOLIS MD
21401-3046
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-9000
  • Fax: 410-571-1670
Mailing address:
  • Phone: 410-571-9000
  • Fax: 410-571-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN KAHAN
Title or Position: PRESIDENT
Credential:
Phone: 410-571-9000