Healthcare Provider Details

I. General information

NPI: 1669236691
Provider Name (Legal Business Name): INNOVATIVE PHYSICAL THERAPY AND FITNESS CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 EASTERN AVE STE 105
BALTIMORE MD
21224-2796
US

IV. Provider business mailing address

9526 PHILADELPHIA RD
ROSEDALE MD
21237-4106
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN MORROW
Title or Position: CEO
Credential: MSPT
Phone: 443-512-8337