Healthcare Provider Details

I. General information

NPI: 1720558950
Provider Name (Legal Business Name): HEALTHPRO PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 INTERNATIONAL CIR STE 100
HUNT VALLEY MD
21030-1387
US

IV. Provider business mailing address

307 INTERNATIONAL CIR STE 100
HUNT VALLEY MD
21030-1387
US

V. Phone/Fax

Practice location:
  • Phone: 410-667-7200
  • Fax:
Mailing address:
  • Phone: 410-667-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARSHA ZATCOFF
Title or Position: DIRECTOR
Credential:
Phone: 864-244-3626