# IMPACT SPORTS & SPINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598506552
- **Authorized official:** DAVID ITSKEVICH DO (CO-FOUNDER/PHYSICIAN)
- **Authorized official phone:** (301) 363-9693

## Contact information

- **Practice address:** 9420 KEY WEST AVE STE 325, ROCKVILLE, MD 20850-6529
- **Practice address phone:** (703) 789-3216
- **Mailing address:** 9420 KEY WEST AVE STE 325, ROCKVILLE, MD 20850-6529

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |

## Other

- **Enumeration date:** 06/04/2024
- **Last updated:** 08/02/2024