=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114883998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALTIMORE INJURY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2025
-----------------------------------------------------
Last Update Date | 12/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 756 WASHINGTON BLVD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21230-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-444-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 WASHINGTON AVE STE 900
-----------------------------------------------------
City | TOWSON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21204-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-494-0100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ATTORNEY
-----------------------------------------------------
Name | FREDDIE J. TRAUB
-----------------------------------------------------
Credential | J.D.
-----------------------------------------------------
Telephone | 410-494-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------