Provider Demographics
NPI:1578223525
Name:MARYLAND SPORTSCARE & REHAB LLC
Entity Type:Organization
Organization Name:MARYLAND SPORTSCARE & REHAB LLC
Other - Org Name:PIVOT PHYSICAL THERAPY OF MARYLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KALI
Authorized Official - Middle Name:N
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 1:305 10TH ST STE 102
Practice Address - Street 2:
Practice Address - City:POCOMOKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21851-1607
Practice Address - Country:US
Practice Address - Phone:410-957-4396
Practice Address - Fax:410-957-4398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty