Healthcare Provider Details

I. General information

NPI: 1780012252
Provider Name (Legal Business Name): BACK ON TRACK REHAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 YORK RD SUITE 224
TOWSON MD
21204-7446
US

IV. Provider business mailing address

7801 YORK RD SUITE 224
TOWSON MD
21204-7446
US

V. Phone/Fax

Practice location:
  • Phone: 443-991-5907
  • Fax: 443-548-0904
Mailing address:
  • Phone: 443-991-5907
  • Fax: 443-548-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SHILPA GANDHI
Title or Position: OFFICE MANAGER
Credential:
Phone: 443-991-5907