Provider Demographics
NPI:1972399319
Name:PELVIC PREP SCHOOL, LLC
Entity type:Organization
Organization Name:PELVIC PREP SCHOOL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:410-279-8231
Mailing Address - Street 1:1803 W ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4546
Mailing Address - Country:US
Mailing Address - Phone:410-279-8231
Mailing Address - Fax:
Practice Address - Street 1:2360 W JOPPA RD STE 315
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4639
Practice Address - Country:US
Practice Address - Phone:410-279-8231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty