Healthcare Provider Details

I. General information

NPI: 1497133953
Provider Name (Legal Business Name): THERAFIT ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220A E JOPPA RD STE 109
TOWSON MD
21286-5816
US

IV. Provider business mailing address

1220A E JOPPA RD STE 109
TOWSON MD
21286-5816
US

V. Phone/Fax

Practice location:
  • Phone: 410-415-1992
  • Fax: 410-774-0488
Mailing address:
  • Phone: 410-415-1992
  • Fax: 410-774-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMD

VIII. Authorized Official

Name: REGINA DELLA
Title or Position: PRESIDENT
Credential:
Phone: 410-371-3329