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Organization
ACTIVE LIFE & SPORTS THERAPY LLC
Active
Organization
ACTIVE LIFE & SPORTS THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH PALMER (OWNER, PRESIDENT)
(410) 949-6639
Entity
Organization
Contact information
Practice address
4337 EBENEZER RD, NOTTINGHAM, MD 21236-2143
(410) 529-3303
(410) 529-7980
Mailing address
4337 EBENEZER RD, NOTTINGHAM, MD 21236-2143
(410) 529-3303
(410) 529-7980
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15366
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
434M
MEDICARE PTAN
MD
01
—
6400507
AARP
MD
01
—
DA1789
RAILROAD MEDICARE
MD
01
—
F517
GHMSI
MD
01
—
KCH3AC
CAREFIRST OF MD
MD
Enumeration date
09/27/2006
Last updated
03/11/2026
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