Basic Information
| Provider Information | |||||||||
| NPI: | 1861131377 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHPRO HERITAGE REHAB & FITNESS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 INTERNATIONAL CIR STE 100 | ||||||||
| Address2: | |||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210301387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154063997 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 BLACK POINT RD | ||||||||
| Address2: | |||||||||
| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040749359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154063997 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2022 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | GUILD | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 4104497996 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0019X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.