Provider Demographics
NPI:1346774718
Name:SPINE AND SPORT ANNAPOLIS LLC
Entity Type:Organization
Organization Name:SPINE AND SPORT ANNAPOLIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:INFANTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-573-5733
Mailing Address - Street 1:134 HOLIDAY CT
Mailing Address - Street 2:STE 305
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7008
Mailing Address - Country:US
Mailing Address - Phone:410-573-5733
Mailing Address - Fax:410-897-9118
Practice Address - Street 1:134 HOLIDAY CT
Practice Address - Street 2:STE 305
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7008
Practice Address - Country:US
Practice Address - Phone:410-573-5733
Practice Address - Fax:410-897-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty