Provider Demographics
NPI:1912129743
Name:SPORT & SPINE REHAB OF FORT WASHINGTON, LLC
Entity Type:Organization
Organization Name:SPORT & SPINE REHAB OF FORT WASHINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-766-0300
Mailing Address - Street 1:11418 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5145
Mailing Address - Country:US
Mailing Address - Phone:240-766-0300
Mailing Address - Fax:240-766-0304
Practice Address - Street 1:11418 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5145
Practice Address - Country:US
Practice Address - Phone:240-766-0300
Practice Address - Fax:240-766-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDIPAOther6115086
1049260OtherASHN CIGNA HMO
DEPT OF LABOROther611056000
MAMSIOther6115086
467BOtherBCBS OF MD
6115086OtherOPTIMUM CHOICE
K219OtherBCBS OF NCA
ALLIANCEOther6115086
7253478OtherAETNA PPO
31816933OtherAETNA HMO
671810OtherCIGNA PPO
K219OtherBCBS OF NCA
=========OtherUNITED HEALTH CARE