# MARYLAND SPORTSCARE & REHAB, LLC

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

## Provider details

- **NPI number:** 1740737584
- **Authorized official:** TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
- **Authorized official phone:** (252) 248-3313

## Contact information

- **Practice address:** 5435 BEAVERKILL RD, COLUMBIA, MD 21044
- **Practice address phone:** (410) 740-0883
- **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 |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 09/09/2016
- **Last updated:** 11/01/2024