# EGONUS BALTIMORE PRO THERAPY AND REHABILITATION PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245618925
- **Authorized official:** INNOCENT EGONU (OWNER)
- **Authorized official phone:** (443) 473-9747

## Contact information

- **Practice address:** 416 EASTERN BLVD, BALTIMORE, MD 21221-6714
- **Practice address phone:** (410) 238-2636
- **Practice address fax:** (410) 238-2601
- **Mailing address:** 416 EASTERN BLVD, BALTIMORE, MD 21221-6714
- **Mailing address phone:** (410) 238-2636
- **Mailing address fax:** (410) 238-2601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 05/13/2015
- **Last updated:** 12/05/2022