Provider Demographics
NPI:1952353039
Name:PROFESSIONAL THERAPY SOLUTIONS LLC
Entity Type:Organization
Organization Name:PROFESSIONAL THERAPY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:TILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-423-2980
Mailing Address - Street 1:10420 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3533
Mailing Address - Country:US
Mailing Address - Phone:410-423-2980
Mailing Address - Fax:443-276-0382
Practice Address - Street 1:6401 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1016
Practice Address - Country:US
Practice Address - Phone:410-377-7774
Practice Address - Fax:410-377-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21-6681OtherMEDICARE PROVIDER NUMBER