Provider Demographics
NPI:1164196952
Name:SAGE PHYSICAL THERAPY & WELLNESS LLC
Entity Type:Organization
Organization Name:SAGE PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CCO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-970-8190
Mailing Address - Street 1:PO BOX 745944
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5944
Mailing Address - Country:US
Mailing Address - Phone:410-970-8177
Mailing Address - Fax:410-313-8024
Practice Address - Street 1:1101 OPAL CT STE 306
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5941
Practice Address - Country:US
Practice Address - Phone:301-790-3929
Practice Address - Fax:301-790-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty