# MARYLAND SPORTSCARE & REHAB, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** PIVOT PHYSICAL THERAPY OF MARYLAND
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407212814
- **Authorized official:** TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
- **Authorized official phone:** (252) 248-3313

## Contact information

- **Practice address:** 504 E RIDGEVILLE BLVD, SUITE 107, MOUNT AIRY, MD 21771-5252
- **Practice address phone:** (301) 829-6811
- **Practice address fax:** (443) 293-7924
- **Mailing address:** 350 NEW FIDELITY CT, GARNER, NC 27529-2665
- **Mailing address phone:** (919) 258-2714
- **Mailing address fax:** (410) 648-4878

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 01/14/2016
- **Last updated:** 10/23/2024