Provider Demographics
NPI:1841207420
Name:LIFE FITNESS PHYSICAL THERAPY OF BOONSBORO
Entity Type:Organization
Organization Name:LIFE FITNESS PHYSICAL THERAPY OF BOONSBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MELIN
Authorized Official - Last Name:TELEMECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-432-6966
Mailing Address - Street 1:9 SAINT PAUL ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1334
Mailing Address - Country:US
Mailing Address - Phone:301-432-6966
Mailing Address - Fax:301-432-8300
Practice Address - Street 1:9 SAINT PAUL ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1334
Practice Address - Country:US
Practice Address - Phone:301-432-6966
Practice Address - Fax:301-432-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD995MMedicare ID - Type Unspecified