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General NPI Number Information
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NPI Number | 1174936579
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Entity Type | Organization
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Legal Business Name | ADVANTAGE LIFE PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 104 CHURCH LN SUITE 126
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City | PIKESVILLE
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State | MD
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Zip | 21208-3786
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Country | US
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Telephone | 410-484-6127
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Fax |
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Provider Business Mailing Address
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Address Line | 104 CHURCH LN
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City | PIKESVILLE
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State | MD
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Zip | 21208-3786
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Country | US
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Telephone | 410-484-6127
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ARLETTA HOLLY
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Credential | PT
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Telephone | 410-458-4557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 20692
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License Number State | MD
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