Healthcare Provider Details

I. General information

NPI: 1649159500
Provider Name (Legal Business Name): PRIME LIGHT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 WOODBRIDGE STATION WAY STE 100-101
EDGEWOOD MD
21040-3852
US

IV. Provider business mailing address

1319 WOODBRIDGE STATION WAY STE 100-101
EDGEWOOD MD
21040-3852
US

V. Phone/Fax

Practice location:
  • Phone: 443-857-7475
  • Fax:
Mailing address:
  • Phone: 443-857-7475
  • Fax: 443-377-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHAKIRAT OLABISI AROWOROWON
Title or Position: OWNER
Credential:
Phone: 443-857-7475