Provider Demographics
NPI:1457504318
Name:PERRY HALL CHIROPRACTIC & PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PERRY HALL CHIROPRACTIC & PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRAVAGLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-256-9650
Mailing Address - Street 1:8817 BELAIR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2425
Mailing Address - Country:US
Mailing Address - Phone:410-256-9650
Mailing Address - Fax:410-256-3339
Practice Address - Street 1:8817 BELAIR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-2445
Practice Address - Country:US
Practice Address - Phone:410-256-9650
Practice Address - Fax:410-256-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN5230000OtherGHMSI
MDF6HFPEOtherCARE FIRST BLUE CROSS BLUE SHIELD
MD138232Medicare PIN