Provider Demographics
NPI:1447605035
Name:PIVOT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PIVOT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DEEPALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADAAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:410-382-6641
Mailing Address - Street 1:10995 OWINGS MILLS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1019
Mailing Address - Country:US
Mailing Address - Phone:410-654-2300
Mailing Address - Fax:443-378-8645
Practice Address - Street 1:10995 OWINGS MILLS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1019
Practice Address - Country:US
Practice Address - Phone:410-654-2300
Practice Address - Fax:443-378-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25739261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy