Provider Demographics
NPI:1245304518
Name:SPORTS AND ORTHOPEDIC THERAPY SERVICES LLC
Entity type:Organization
Organization Name:SPORTS AND ORTHOPEDIC THERAPY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MA PT SCS
Authorized Official - Phone:301-946-7717
Mailing Address - Street 1:10605 CONCORD STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895
Mailing Address - Country:US
Mailing Address - Phone:301-946-7717
Mailing Address - Fax:301-946-8794
Practice Address - Street 1:10605 CONCORD STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895
Practice Address - Country:US
Practice Address - Phone:301-946-7717
Practice Address - Fax:301-946-8794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2007-09-11
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
MD833335Medicare PIN