Healthcare Provider Details

I. General information

NPI: 1730801309
Provider Name (Legal Business Name): INTEGRATED FITNESS AND REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 CONCORD BLVD STE A
CROFTON MD
21114-2055
US

IV. Provider business mailing address

917 WAUGH CHAPEL RD
GAMBRILLS MD
21054-1246
US

V. Phone/Fax

Practice location:
  • Phone: 443-980-4650
  • Fax:
Mailing address:
  • Phone: 443-980-4650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN CREGER
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 443-980-4650