Organization Name: | LIFEBRIDGE SPORTS MEDICINE & REHABILITATION, LLC |
NPI Number: | 1114224268 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL E TARVIN (VICE PRESIDENT & SECRETARY) |
Mailing Address: | 750 Main St Reisterstown |
State: | MD US |
Postal Code: | 211362515 |
Phone Number: | 4105263030 |
Fax Number: | 4105263037 |
NPI Enumeration Date: | 02/24/2011 |
NPI Last Update Date: | 04/28/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |