Provider Demographics
NPI:1922509603
Name:GAIT DYNAMICS LLC
Entity Type:Organization
Organization Name:GAIT DYNAMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DANNELLY
Authorized Official - Last Name:LOGUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:443-487-4394
Mailing Address - Street 1:3800 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3530
Mailing Address - Country:US
Mailing Address - Phone:443-487-4394
Mailing Address - Fax:240-482-8839
Practice Address - Street 1:4000 OLD COURT RD STE 105A
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:443-487-4394
Practice Address - Fax:240-482-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty