Provider Demographics
NPI:1770650392
Name:SPORTS PHYSICAL THERAPY OF TOWSON, P.A.
Entity Type:Organization
Organization Name:SPORTS PHYSICAL THERAPY OF TOWSON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-583-0333
Mailing Address - Street 1:7801 YORK RD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7446
Mailing Address - Country:US
Mailing Address - Phone:410-583-0333
Mailing Address - Fax:410-583-2134
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:SUITE 236
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:410-583-0333
Practice Address - Fax:410-583-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2010-07-29
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
MDKR29SPOtherCAREFIRST
MD222778900Medicaid
MD222778900Medicaid