Provider Demographics
NPI:1780012252
Name:BACK ON TRACK REHAB SERVICES LLC
Entity Type:Organization
Organization Name:BACK ON TRACK REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHILPA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-991-5907
Mailing Address - Street 1:7801 YORK RD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7446
Mailing Address - Country:US
Mailing Address - Phone:443-991-5907
Mailing Address - Fax:443-548-0904
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:SUITE 224
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:443-991-5907
Practice Address - Fax:443-548-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty