Healthcare Provider Details

I. General information

NPI: 1205594603
Provider Name (Legal Business Name): AARON PUREC RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/02/2021
Certification Date: 10/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 REDLAND CT
OWINGS MILLS MD
21117-3264
US

IV. Provider business mailing address

3101 SHELBURNE RD
BALTIMORE MD
21208-5622
US

V. Phone/Fax

Practice location:
  • Phone: 443-738-5110
  • Fax:
Mailing address:
  • Phone: 410-501-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: