Provider Demographics
NPI:1467155499
Name:IMPACT SPORTS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:IMPACT SPORTS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-684-5642
Mailing Address - Street 1:8816 DOVE DR
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9000
Mailing Address - Country:US
Mailing Address - Phone:410-684-5642
Mailing Address - Fax:443-632-0521
Practice Address - Street 1:121 INDUSTRY LN
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-1621
Practice Address - Country:US
Practice Address - Phone:410-684-5642
Practice Address - Fax:443-632-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty