Provider Demographics
NPI:1700803384
Name:BACKE, PETER (PT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:BACKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655A OLD COURT RD
Mailing Address - Street 2:STE 16
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3959
Mailing Address - Country:US
Mailing Address - Phone:410-484-5500
Mailing Address - Fax:410-486-3220
Practice Address - Street 1:3655A OLD COURT RD
Practice Address - Street 2:STE 16
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3959
Practice Address - Country:US
Practice Address - Phone:410-484-5500
Practice Address - Fax:410-486-3220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD538SMedicare PIN