Provider Demographics
NPI:1609269612
Name:TOTAL SPORTS REHAB AND PHYSICAL THERAPY OF MARYLAND LLC.
Entity Type:Organization
Organization Name:TOTAL SPORTS REHAB AND PHYSICAL THERAPY OF MARYLAND LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:443-798-0414
Mailing Address - Street 1:5834 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-1413
Mailing Address - Country:US
Mailing Address - Phone:443-798-0414
Mailing Address - Fax:410-668-6612
Practice Address - Street 1:5834 EAST AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1413
Practice Address - Country:US
Practice Address - Phone:443-798-0414
Practice Address - Fax:410-668-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22267261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy