Provider Demographics
NPI:1285701367
Name:HER HEALTH PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:HER HEALTH PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:443-283-2018
Mailing Address - Street 1:10705 CHARTER DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2893
Mailing Address - Country:US
Mailing Address - Phone:443-283-2018
Mailing Address - Fax:443-283-0628
Practice Address - Street 1:10705 CHARTER DR
Practice Address - Street 2:SUITE 420
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2893
Practice Address - Country:US
Practice Address - Phone:443-283-2018
Practice Address - Fax:443-283-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD201382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD428PMedicare PIN