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General NPI Number Information
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NPI Number | 1326411877
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Entity Type | Organization
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Legal Business Name | STRUCTURAL ELEMENTS, LLC
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 13214 FOUNTAINHEAD PLAZA
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City | HAGERSTOWN
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State | MD
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Zip | 21742
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Country | US
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Telephone | 301-766-9293
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Fax |
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Provider Business Mailing Address
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Address Line | 13214 FOUNTAINHEAD PLAZA
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City | HAGERSTOWN
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State | MD
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Zip | 21742
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Country | US
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Telephone | 301-766-9293
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DOUGLAS E BERTRAM
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Credential | L.AC
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Telephone | 301-766-9293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U02058
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 24958
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M05356
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M05395
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 23476
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License Number State | MD
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