Provider Demographics
NPI:1669450920
Name:CROFTON PHYSICAL THERAPY & SPORTS REHAB, INC.
Entity Type:Organization
Organization Name:CROFTON PHYSICAL THERAPY & SPORTS REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-721-9000
Mailing Address - Street 1:2200 DEFENSE HWY
Mailing Address - Street 2:200
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2926
Mailing Address - Country:US
Mailing Address - Phone:410-721-9000
Mailing Address - Fax:410-721-8185
Practice Address - Street 1:2200 DEFENSE HWY
Practice Address - Street 2:200
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2926
Practice Address - Country:US
Practice Address - Phone:410-721-9000
Practice Address - Fax:410-721-8185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKY69CROtherCAREFIRST BC/BS GROUP NUM
MD5001459OtherAETNA PPO GROUP NUMBER
MD2598572OtherAETNA HMO GROUP NUMBER
MDR926OtherCAREFIRST BC/BS HMO/FEP
MDKY69CROtherCAREFIRST BC/BS GROUP NUM