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Organization
PROFESSIONAL SPORTSCARE, LLC
Active
Organization
PROFESSIONAL SPORTSCARE, LLC
Active
Other names
Pivot Physical Therapy of Maryland/Greater Baltimore
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY L PEARSON (DIRECTOR)
(443) 225-4492
Entity
Organization
Contact information
Practice address
2634 BRANDERMILL BLVD, GAMBRILLS, MD 21054-1651
(410) 721-7201
Mailing address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 258-2714
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18GMMA
CAREFIRST BCBS OF MARYLAND
—
01
—
5120
BLUECHOICE/GHMSI
—
01
—
701076
ACN
—
Enumeration date
06/22/2006
Last updated
10/31/2019
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