Organization
515 BRIGHTFIELD ROAD OPERATIONS LLC
Active
Other names
PowerBack Rehabilitation, Brightwood Campus
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
515 BRIGHTFIELD RD, LUTHERVILLE, MD 21093-3643
(410) 296-1990
Mailing address
515 BRIGHTFIELD RD, LUTHERVILLE, MD 21093-3643
(410) 296-1990
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
03017
MD
225X00000X
Occupational Therapist
03017
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
442505700
—
MD
Enumeration date
04/21/2016
Last updated
09/07/2017
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