Provider Demographics
NPI:1578273629
Name:STRIVE SPORTS MEDICINE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:STRIVE SPORTS MEDICINE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:443-370-2106
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-0475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:443-775-7728
Practice Address - Street 1:112 W GORDY RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-3309
Practice Address - Country:US
Practice Address - Phone:410-324-3301
Practice Address - Fax:443-775-7728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRIVE SPORTS MEDICINE PHYSICAL THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty