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General NPI Number Information
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NPI Number | 1013117241
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Entity Type | Organization
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Legal Business Name | LIFEBRIDGE HEALTH AND FITNESS LLC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 1836 GREENE TREE RD
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City | BALTIMORE
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State | MD
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Zip | 21208-1381
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Country | US
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Telephone | 410-484-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 GREENE TREE RD
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City | BALTIMORE
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State | MD
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Zip | 21208-1381
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Country | US
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Telephone | 410-484-6800
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Fax | 410-484-6804
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JARED FAJERSKI
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Credential |
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Telephone | 410-318-6816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0404X
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Taxonomy Name | Cardiac Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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