Provider Demographics
NPI:1972675858
Name:SPORT & FAMILY PHYSICAL THERAPY, LLC.
Entity Type:Organization
Organization Name:SPORT & FAMILY PHYSICAL THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TOROCKIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-552-5632
Mailing Address - Street 1:1160 BREITEN CT
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-9205
Mailing Address - Country:US
Mailing Address - Phone:410-795-3289
Mailing Address - Fax:
Practice Address - Street 1:2470 LONGSTONE LANE
Practice Address - Street 2:SUITE K
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104
Practice Address - Country:US
Practice Address - Phone:410-442-2470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty