NPI 1174349575 · live from the CMS NPI Registry
Active 360 Therapy
Physical Therapist in Baltimore, MD. National Provider Identifier 1174349575, active.
NPI record
| NPI | 1174349575 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Physical Therapist 225100000X |
| Practice location | 6212 York Rd, Baltimore, MD 21212 |
| Practice phone | 301-776-8103 |
| Mailing address | 6801 Oak Hall Ln Unit 6462, Columbia, MD 21045 |
| Enumerated | December 2, 2024 |
| Last updated | October 10, 2025 |
| Authorized official | Calista Chana, Ceo |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Speech-Language Pathologist, | 235Z00000X | — |
| Home Health | 251E00000X | — |
| Social Worker | 104100000X | — |
| Occupational Therapist | 225X00000X | — |
| Registered Nurse, Home Health | 163WH0200X | — |
| Physical Therapist primary | 225100000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.