Healthcare Provider Details

I. General information

NPI: 1922509603
Provider Name (Legal Business Name): GAIT DYNAMICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLD COURT RD STE 105A
PIKESVILLE MD
21208-2800
US

IV. Provider business mailing address

3800 GLEN AVE
BALTIMORE MD
21215-3530
US

V. Phone/Fax

Practice location:
  • Phone: 443-487-4394
  • Fax: 240-482-8839
Mailing address:
  • Phone: 443-487-4394
  • Fax: 240-482-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN DANNELLY LOGUE JR.
Title or Position: OWNER
Credential: CPO
Phone: 443-487-4394