Provider Demographics
NPI:1871224220
Name:SAGE PHYSICAL THERAPY & WELLNESS, LLC
Entity Type:Organization
Organization Name:SAGE PHYSICAL THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-970-8177
Mailing Address - Street 1:PO BOX 745944
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5944
Mailing Address - Country:US
Mailing Address - Phone:410-970-8177
Mailing Address - Fax:410-313-8024
Practice Address - Street 1:4000 OLD COURT RD STE 100
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2891
Practice Address - Country:US
Practice Address - Phone:410-415-0005
Practice Address - Fax:410-415-0006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAGE PHYSICAL THERAPY & WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty