Provider Demographics
NPI:1538326533
Name:ADVANTAGE FITNESS & REHABILITATION LLC
Entity Type:Organization
Organization Name:ADVANTAGE FITNESS & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMMEL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:410-750-7500
Mailing Address - Street 1:6336 CEDAR LN
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3897
Mailing Address - Country:US
Mailing Address - Phone:410-750-7500
Mailing Address - Fax:
Practice Address - Street 1:6336 CEDAR LN
Practice Address - Street 2:SUITE 150
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3897
Practice Address - Country:US
Practice Address - Phone:410-750-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation