1780012252 NPI number — BACK ON TRACK REHAB SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780012252 NPI number — BACK ON TRACK REHAB SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK ON TRACK REHAB SERVICES 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:
Provider Other Organization Name Type Code:
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:
1780012252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7801 YORK RD
Provider Second Line Business Mailing Address:
SUITE 224
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-7446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-991-5907
Provider Business Mailing Address Fax Number:
443-548-0904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7801 YORK RD
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-7446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-991-5907
Provider Business Practice Location Address Fax Number:
443-548-0904
Provider Enumeration Date:
10/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GANDHI
Authorized Official First Name:
SHILPA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
443-991-5907

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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