Provider Demographics
NPI:1205992971
Name:MARYLAND SPORTSCARE & REHABILITATION OF SALISBURY, LLC
Entity type:Organization
Organization Name:MARYLAND SPORTSCARE & REHABILITATION OF SALISBURY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOVIENE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-829-5647
Mailing Address - Street 1:732 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5037
Mailing Address - Country:US
Mailing Address - Phone:443-260-3050
Mailing Address - Fax:443-260-3051
Practice Address - Street 1:732 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5037
Practice Address - Country:US
Practice Address - Phone:443-260-3050
Practice Address - Fax:443-260-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
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
MDLV43OtherBC
F106OtherBCHOICE-FEDERAL #
MD023MMedicare ID - Type Unspecified