515 Brightfield Road Operations LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

03017 Issued in MD

Legal business name

515 BRIGHTFIELD ROAD OPERATIONS LLC

Doing business as

PowerBack Rehabilitation, Brightwood Campus

Practice address

515 Brightfield Rd
Lutherville, MD 21093-3643

Phone

(410) 296-1990

NPI assigned

Apr 21, 2016

Organization subpart

No

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

Authorized official

Name

Michael T. Berg

Title

Assistant Secretary

Phone

(505) 468-4752

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• PowerBack Rehabilitation, Brightwood Campus Doing business as

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

{
    "created_epoch": "1461196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504742400000",
    "number": "1760836142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 BRIGHTFIELD RD",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210933643",
            "telephone_number": "410-296-1990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 BRIGHTFIELD RD",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210933643",
            "telephone_number": "410-296-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "515 BRIGHTFIELD ROAD OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-21",
        "last_updated": "2017-09-07",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "03017",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "03017",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "442505700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PowerBack Rehabilitation, Brightwood Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 515 Brightfield Road Opco LLC
• 515 Brightfield Road Operations LLC (PowerBack Rehabilitation Brightwood Campus)
• A Better Living Wellness Center
• Ihsan Abdul Jabbar, PTA
• Shahab Naheed Abidi, MD
• Ariella Abraham, PSY.D.
• Christy Rose Abraham

• Physical Therapist in Lutherville, MD
• Providers in Lutherville, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.