NPIMap

Organization Active NPI

Life Fitness Physical Therapy LLC

  • Physical Therapist
  • Baltimore, MD
National Provider Identifier
1215185608
Registry record updated Aug 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LIFE FITNESS PHYSICAL THERAPY LLC
Practice address
3350 Wilkens Ave
Suite 303
Baltimore, MD 21229-4600
Phone
(410) 368-1026
Fax
(410) 368-1047
NPI assigned
Aug 28, 2008
Last updated
Aug 28, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFE FITNESS PHYSICAL THERAPY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janna P King
Title
VP, Authorized Official
Phone
(713) 297-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

3350 Wilkens Ave
Suite 303
Baltimore, MD 21229-4600

Mailing address

3350 Wilkens Ave
Suite 303
Baltimore, MD 21229-4600
Phone (410) 368-1026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041117000899 MD Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2466416581 Receives reassigned benefits from 6 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ellicott City, MD; Owings Mills, MD; Towson, MD

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Life Fitness Phyl Thpy LLC

Locations

3350 Wilkens Ave
Ste 303
Baltimore, MD 21229
Phone (410) 368-1023

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219881600000",
    "number": "1215185608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 WILKENS AVE",
            "address_2": "SUITE 303",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212294600",
            "telephone_number": "410-368-1026",
            "fax_number": "410-368-1047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 WILKENS AVE",
            "address_2": "SUITE 303",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212294600",
            "telephone_number": "410-368-1026",
            "fax_number": "410-368-1047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE FITNESS PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFE FITNESS PHYSICAL THERAPY LLC",
        "enumeration_date": "2008-08-28",
        "last_updated": "2008-08-28",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "JANNA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VP, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "713-297-7000"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.