Provider Demographics
NPI:1619012788
Name:SALISBURY PHYSICAL THERAPY & SPORTSMEDICINE
Entity Type:Organization
Organization Name:SALISBURY PHYSICAL THERAPY & SPORTSMEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-543-9000
Mailing Address - Street 1:949 MOUNT HERMON RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5105
Mailing Address - Country:US
Mailing Address - Phone:410-543-9000
Mailing Address - Fax:410-543-9033
Practice Address - Street 1:949 MOUNT HERMON RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5105
Practice Address - Country:US
Practice Address - Phone:410-543-9000
Practice Address - Fax:410-543-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD44002OtherMAMSI
MDS4020003OtherBLUE CHOICE
MD52788201OtherCAREFIRST
MDS4020003OtherBLUE CHOICE