Healthcare Provider Details

I. General information

NPI: 1457504318
Provider Name (Legal Business Name): PERRY HALL CHIROPRACTIC & PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8817 BELAIR RD SUITE 101
BALTIMORE MD
21236-2445
US

IV. Provider business mailing address

8817 BELAIR RD SUITE 101
BALTIMORE MD
21236-2425
US

V. Phone/Fax

Practice location:
  • Phone: 410-256-9650
  • Fax: 410-256-3339
Mailing address:
  • Phone: 410-256-9650
  • Fax: 410-256-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS R TRAVAGLINE
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 410-256-9650