Provider Demographics
NPI:1497133953
Name:THERAFIT ENTERPRISES, INC.
Entity Type:Organization
Organization Name:THERAFIT ENTERPRISES, INC.
Other - Org Name:THERAFIT GYM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-371-3329
Mailing Address - Street 1:1220A E JOPPA RD STE 109
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5816
Mailing Address - Country:US
Mailing Address - Phone:410-415-1992
Mailing Address - Fax:410-774-0488
Practice Address - Street 1:1220A E JOPPA RD STE 109
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5816
Practice Address - Country:US
Practice Address - Phone:410-415-1992
Practice Address - Fax:410-774-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104100000X, 225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD753702601Medicaid
MD753702601Medicaid