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Organization
SPORTS PRO PHYSICAL THERAPY LLC
Active
Organization
SPORTS PRO PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARYL ANDREW CLARKE PT (DIRECTOR OF PT OWNER)
(301) 599-8899
Entity
Organization
Contact information
Practice address
9440 PENNSYLVANIA AVE, # 215, UPPER MARLBORO, MD 20772
(301) 599-8899
(301) 599-8878
Mailing address
12200 ANNAPOLIS RD, #119, GLENN DALE, MD 20769-9182
(301) 599-8899
(301) 599-8878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
18090
MD
225100000X
Physical Therapist
2800
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101837200
DOL OWCP
—
01
—
2320527
UNITED HEALTHCARE MID ATL
—
01
—
270001084
CORVEL
—
01
—
3204256
AETNA HMO
—
01
—
466223
MAMSI PROVIDER NUMBER
—
01
—
523780
NCPPO PROVIDER
—
01
—
68640202
PROVIDER CAREFIRST BLUECR
—
01
—
7910288
AETNA PPO
—
01
—
H853001
CAREFIRST BLUE CROSS BLUE
—
01
—
KER3SP
GRP CAREFIRST BLUE CROSS
—
Enumeration date
12/28/2005
Last updated
09/01/2015
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