Provider Demographics
NPI:1790808855
Name:SPRING RIDGE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SPRING RIDGE PHYSICAL THERAPY
Other - Org Name:SUPERIOR PHYSICAL THERAPY AND SPORTS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:FORBES
Authorized Official - Last Name:COX
Authorized Official - Suffix:III
Authorized Official - Credentials:MSPT
Authorized Official - Phone:301-696-5595
Mailing Address - Street 1:9093 RIDGEFIELD DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6712
Mailing Address - Country:US
Mailing Address - Phone:301-696-5595
Mailing Address - Fax:301-696-0843
Practice Address - Street 1:9093 RIDGEFIELD DR STE 201
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6712
Practice Address - Country:US
Practice Address - Phone:301-696-5595
Practice Address - Fax:301-696-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6383450001Medicare NSC
MD427MMedicare PIN