NPIMap

Organization Active NPI

Life Fitness Physical Therapy LLC

  • Physical Therapist
  • Ellicott City, MD
National Provider Identifier
1285882670
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
9171 Baltimore National Pike
Suite 120
Ellicott City, MD 21042-3944
Phone
(410) 480-3705
Fax
(410) 480-3707
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 King
Title
VP, Authorized Official
Phone
(713) 297-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

9171 Baltimore National Pike
Suite 120
Ellicott City, MD 21042-3944

Mailing address

9171 Baltimore National Pike
Suite 120
Ellicott City, MD 21042-3944
Phone (410) 480-3705

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
Tax ID family
Life Fitness Phyl Thpy LLC3 organizations share this tax ID, including this one
Part of
Life Fitness Phyl Thpy LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9171 Baltimore National Pike
Ste 120
Ellicott City, MD 21042
Phone (410) 480-3705

Practitioners & affiliated clinicians

Practitioners 141

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 141

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": "1285882670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9171 BALTIMORE NATIONAL PIKE",
            "address_2": "SUITE 120",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210423944",
            "telephone_number": "410-480-3705",
            "fax_number": "410-480-3707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9171 BALTIMORE NATIONAL PIKE",
            "address_2": "SUITE 120",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210423944",
            "telephone_number": "410-480-3705",
            "fax_number": "410-480-3707"
        }
    ],
    "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_title_or_position": "VP, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "713-297-7000"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, 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.