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General NPI Number Information
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NPI Number | 1861085607
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Entity Type | Organization
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Legal Business Name | PINE HEIGHTS INTEGRATIVE HEALTH, LLC
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Dates
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Enumeration Date | 02/12/2021
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 1001 PINE HEIGHTS AVE STE 304
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City | BALTIMORE
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State | MD
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Zip | 21229-5285
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Country | US
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Telephone | 240-614-6369
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Fax | 301-476-0418
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Provider Business Mailing Address
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Address Line | 30 W GUDE DR STE 375
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City | ROCKVILLE
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State | MD
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Zip | 20850-4300
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Country | US
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Telephone | 240-614-6369
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Fax | 301-545-0885
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PHYLLIS BLACKWELL
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Credential |
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Telephone | 301-575-6549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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