Healthcare Provider Details

I. General information

NPI: 1144905092
Provider Name (Legal Business Name): INFINITY WELLNESS & FITNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10060 WINCOPIA FARMS WAY
LAUREL MD
20723-5792
US

IV. Provider business mailing address

10060 WINCOPIA FARMS WAY
LAUREL MD
20723-5792
US

V. Phone/Fax

Practice location:
  • Phone: 301-957-8896
  • Fax:
Mailing address:
  • Phone: 240-583-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL JOSEPH
Title or Position: OWNER
Credential:
Phone: 240-583-0862