Healthcare Provider Details

I. General information

NPI: 1972184505
Provider Name (Legal Business Name): THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 GUILFORD RD STE 140
COLUMBIA MD
21046-2394
US

IV. Provider business mailing address

8599 HAYSHED LN
COLUMBIA MD
21045-2614
US

V. Phone/Fax

Practice location:
  • Phone: 443-542-2480
  • Fax: 443-296-6707
Mailing address:
  • Phone: 443-286-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOI GADDY EGBUNIWE
Title or Position: OWNER
Credential: DC
Phone: 443-286-7270