Provider Demographics
NPI:1376272732
Name:HEALTHPRO HERITAGE REHAB & FITNESS, LLC
Entity Type:Organization
Organization Name:HEALTHPRO HERITAGE REHAB & FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COUNSEL/AO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-449-7996
Mailing Address - Street 1:PO BOX 69211
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9211
Mailing Address - Country:US
Mailing Address - Phone:615-406-3997
Mailing Address - Fax:
Practice Address - Street 1:377 NW JASPER ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1279
Practice Address - Country:US
Practice Address - Phone:864-244-3626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty