Organization · NPI-2

115 East Melrose Avenue Operations LLC

Physical Therapist · Baltimore, MD

NPI number1235583600
StatusActive
Last updated in NPPESSep 7, 2017

Details

NPI
1235583600
Entity type
Organization (NPI-2)
Legal business name
115 East Melrose Avenue Operations LLC
Organization subpart
No
Enumeration date
Apr 21, 2016
Last updated
Sep 7, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225100000X Physical Therapist30044MDYes
225X00000X Occupational Therapist30044MD

Other names

  • Long Green Center (Doing Business As)

Practice location

115 E Melrose Ave
Baltimore, MD 21212-2945

Phone 410-435-9073

Mailing address

115 E Melrose Ave
Baltimore, MD 21212-2945

Phone 410-435-9073

Authorized official

Michael T. Berg
Assistant Secretary
5054684752

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