Provider Demographics
NPI:1548418932
Name:LIFE FITNESS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:LIFE FITNESS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRANCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:1406B CRAIN HWY S
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4099
Mailing Address - Country:US
Mailing Address - Phone:410-590-2334
Mailing Address - Fax:410-590-2336
Practice Address - Street 1:9110 PHILADELPHIA RD STE 104
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4323
Practice Address - Country:US
Practice Address - Phone:410-686-8922
Practice Address - Fax:410-686-8923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE FITNESS PHYSICAL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-28
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD008NMedicare PIN