Healthcare Provider Details

I. General information

NPI: 1821853441
Provider Name (Legal Business Name): FITNESS FORUM OF MARYLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 HOLLY AVE STE 200
ANNAPOLIS MD
21401-8539
US

IV. Provider business mailing address

659 S SALISBURY BLVD STE 1B
SALISBURY MD
21801-5458
US

V. Phone/Fax

Practice location:
  • Phone: 410-295-4941
  • Fax: 410-295-5207
Mailing address:
  • Phone: 410-831-3226
  • Fax: 410-572-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JANICE M BALDWIN
Title or Position: REGIONAL MANAGER
Credential:
Phone: 410-831-3226