Provider Demographics
NPI:1740569383
Name:TEAM SPORTS INJURY CONSULTING, LLC
Entity Type:Organization
Organization Name:TEAM SPORTS INJURY CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KALA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:FLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, ATC, CSCS
Authorized Official - Phone:240-281-6821
Mailing Address - Street 1:9806 SPANISH OAK WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3716
Mailing Address - Country:US
Mailing Address - Phone:240-281-6821
Mailing Address - Fax:301-925-4591
Practice Address - Street 1:379 FIELD HOUSE DR
Practice Address - Street 2:RM 109
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742-0001
Practice Address - Country:US
Practice Address - Phone:240-281-6821
Practice Address - Fax:301-314-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20046261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy