Basic Information
| Provider Information | |||||||||
| NPI: | 1326151515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BSR PHYSICAL THERAPY AND REHABILITATION AGENCY INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 ORVILLE ROAD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106862270 | ||||||||
| FaxNumber: | 4106865447 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 ORVILLE ROAD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106862270 | ||||||||
| FaxNumber: | 4106865447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | PREVAS | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4105150006 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.