1033161187 NPI number — PROFESSIONAL THERAPY SOLUTIONS LLC

Table of content: (NPI 1033161187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033161187 NPI number — PROFESSIONAL THERAPY SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL THERAPY SOLUTIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROFESSIONAL THERAPY SOLUTIONS - VA
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033161187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10420 LITTLE PATUXENT PKWY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-3533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-423-2980
Provider Business Mailing Address Fax Number:
443-276-0382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
512 HOUSTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAUNTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24401-3525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-886-2335
Provider Business Practice Location Address Fax Number:
540-886-0781
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TILLES
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
410-423-2980

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 49-6707 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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