Provider Demographics
NPI:1831662444
Name:THERAFIT ENTERPRISES, INC.
Entity Type:Organization
Organization Name:THERAFIT ENTERPRISES, INC.
Other - Org Name:THERAFIT REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-871-2494
Mailing Address - Street 1:511 JERMOR LN STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6152
Mailing Address - Country:US
Mailing Address - Phone:410-871-2494
Mailing Address - Fax:
Practice Address - Street 1:7138 WINDSOR BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2705
Practice Address - Country:US
Practice Address - Phone:443-364-8182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAFIT ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD753702604Medicaid