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Organization
THE WELLSPRING CENTER
Active
Organization
THE WELLSPRING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETH WALLACE LUSKY (OWNER)
(410) 836-9622
Entity
Organization
Contact information
Practice address
1216 RUNNYMEDE LANE, THE WELLSPRING CENTER, BEL AIR, MD 21014
(410) 836-9622
(410) 836-8632
Mailing address
PO BOX 976, 1216 RUNNYMEDE LANE, BEL AIR, MD 21014
(410) 836-9622
(410) 836-8632
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15945
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
620462
UNITED
—
01
—
KDA5WE
BCBS
—
Enumeration date
08/31/2006
Last updated
10/22/2011
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