Healthcare Provider Details

I. General information

NPI: 1861824963
Provider Name (Legal Business Name): MSI BEL AIR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 BALTIMORE PIKE
BEL AIR MD
21014-4244
US

IV. Provider business mailing address

730 BALTIMORE PIKE
BEL AIR MD
21014-4244
US

V. Phone/Fax

Practice location:
  • Phone: 410-877-8077
  • Fax: 410-877-8577
Mailing address:
  • Phone: 410-877-8077
  • Fax: 410-877-8577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS03558
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20804
License Number StateMD

VIII. Authorized Official

Name: DR. ROCHELIN HEROLD
Title or Position: DIRECTOR
Credential: DC, MS, CEAS
Phone: 410-877-8077