Provider Demographics
NPI:1871072462
Name:HEALTHPRO HERITAGE REHAB & FITNESS, LLC
Entity type:Organization
Organization Name:HEALTHPRO HERITAGE REHAB & FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR LICENSURE AND CERTIFICATION
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGLASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-406-3997
Mailing Address - Street 1:PO BOX 69211
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-1969
Mailing Address - Country:US
Mailing Address - Phone:615-406-3997
Mailing Address - Fax:
Practice Address - Street 1:2100 S SWOPE DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2808
Practice Address - Country:US
Practice Address - Phone:816-708-4462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty