Provider Demographics
NPI:1477211704
Name:PIVOT PHYSICAL THERAPY OF CENTRAL MARYLAND LLC
Entity Type:Organization
Organization Name:PIVOT PHYSICAL THERAPY OF CENTRAL MARYLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MNAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRANKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-566-4186
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:3570 SAINT JOHNS LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4020
Practice Address - Country:US
Practice Address - Phone:919-258-2714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty