# LIFE FITNESS PHYSICAL THERAPY OF ELLICOTT CITY, LLC

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

## Provider details

- **NPI number:** 1962559476
- **Authorized official:** JANNA KING (VP, AUTHORIZED OFFICIAL)
- **Authorized official phone:** (713) 297-7000

## Contact information

- **Practice address:** 9171 BALTIMORE NATIONAL PIKE, SUITE 120, ELLICOTT CITY, MD 21042-3922
- **Practice address phone:** (410) 480-3705
- **Practice address fax:** (410) 480-3707
- **Mailing address:** 9171 BALTIMORE NATIONAL PIKE, SUITE 120, ELLICOTT CITY, MD 21042-3922
- **Mailing address phone:** (410) 480-3705
- **Mailing address fax:** (410) 480-3707

## Taxonomy

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

## Other

- **Enumeration date:** 01/05/2007
- **Last updated:** 10/02/2008