Organization · NPI-2

Spine & Sports Physical Therapy & Diagnostics, LLC

Physical Therapist · Glen Burnie, MD

NPI number1083077499
StatusActive
Last updated in NPPESApr 4, 2016

Details

NPI
1083077499
Entity type
Organization (NPI-2)
Legal business name
Spine & Sports Physical Therapy & Diagnostics, LLC
Organization subpart
No
Enumeration date
Apr 2, 2016
Last updated
Apr 4, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225100000X Physical Therapist––Yes
2084N0400X Psychiatry & Neurology, Neurology––

Practice location

1406b Crain Hwy S
Suite 107
Glen Burnie, MD 21061-4099

Phone 410-625-5050 · Fax 410-766-1404

Mailing address

1406b Crain Hwy S
Suite 107
Glen Burnie, MD 21061-4099

Phone 410-625-5050 · Fax 410-766-1404

Authorized official

Charles Davis
Sole Member
4106255050

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