Healthcare Provider Details

I. General information

NPI: 1841207420
Provider Name (Legal Business Name): LIFE FITNESS PHYSICAL THERAPY OF BOONSBORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SAINT PAUL ST 3RD FLOOR
BOONSBORO MD
21713-1334
US

IV. Provider business mailing address

9 SAINT PAUL ST 3RD FLOOR
BOONSBORO MD
21713-1334
US

V. Phone/Fax

Practice location:
  • Phone: 301-432-6966
  • Fax: 301-432-8300
Mailing address:
  • Phone: 301-432-6966
  • Fax: 301-432-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBIN MELIN TELEMECO
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-432-6966