Healthcare Provider Details

I. General information

NPI: 1093345894
Provider Name (Legal Business Name): BEYOND LIMITS MOBILE OUTPATIENT THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BALTUSROL DR
CHARLES TOWN WV
25414-3884
US

IV. Provider business mailing address

41 BALTUSROL DR
CHARLES TOWN WV
25414-3884
US

V. Phone/Fax

Practice location:
  • Phone: 304-216-2979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SUE BALTUSNIK
Title or Position: OWNER
Credential: OTR
Phone: 304-216-2979