Healthcare Provider Details

I. General information

NPI: 1538583646
Provider Name (Legal Business Name): TO THE CORE PHYSICAL THERAPY & CONDITIONING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E JOPPA RD STE LL102
TOWSON MD
21286-3105
US

IV. Provider business mailing address

200 E JOPPA RD STE LL102
TOWSON MD
21286-3105
US

V. Phone/Fax

Practice location:
  • Phone: 410-967-4691
  • Fax:
Mailing address:
  • Phone: 410-967-4691
  • Fax: 443-773-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CARRIE KRUG
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 410-967-4691