MEDICARE: MR. PETER BACKE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	17348	MD

General Provider Information

NPI Number	:	1700803384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER BACKE P.T.

Provider Business Mailing Address
First Line	:	3655A OLD COURT RD
Second Line	:	STE 16
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-3959
Country	:	US
Telephone Number	:	410-484-5500
Fax Number	:	410-486-3220

Provider Business Practice Location Address
First Line	:	3655A OLD COURT RD
Second Line	:	STE 16
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-3959
Country	:	US
Telephone Number	:	410-484-5500
Fax Number	:	410-486-3220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/30/2008

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