Provider Demographics
NPI:1720534852
Name:SOUTHERN DELAWARE SPORTSCARE AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:SOUTHERN DELAWARE SPORTSCARE AND REHABILITATION, LLC
Other - Org Name:PIVOT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-885-6371
Mailing Address - Street 1:501 FAIRMOUNT AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5457
Mailing Address - Country:US
Mailing Address - Phone:410-927-8768
Mailing Address - Fax:
Practice Address - Street 1:26089 SHOPPES AT LONG NECK BLVD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-5981
Practice Address - Country:US
Practice Address - Phone:302-424-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty