Provider Demographics
NPI:1710411558
Name:INNOVATIVE PHYSICAL THERAPY AND FITNESS CENTERS LLC
Entity Type:Organization
Organization Name:INNOVATIVE PHYSICAL THERAPY AND FITNESS CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:302-528-4019
Mailing Address - Street 1:100 WALTER WARD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1285
Mailing Address - Country:US
Mailing Address - Phone:302-528-4019
Mailing Address - Fax:
Practice Address - Street 1:100 WALTER WARD BLVD
Practice Address - Street 2:UNIT 200
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009
Practice Address - Country:US
Practice Address - Phone:302-528-4019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 261QM1300X
MD23639261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy