# MARYLAND SPORTSCARE & REHAB LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pivot Physical Therapy of Maryland
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871154856
- **Authorized official:** TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
- **Authorized official phone:** (252) 248-3313

## Contact information

- **Practice address:** 3100 BOSTON STREET, BALTIMORE, MD 21298-0001
- **Practice address phone:** (919) 258-2714
- **Mailing address:** 350 NEW FIDELITY CT, GARNER, NC 27529-2665
- **Mailing address phone:** (919) 258-2714

## 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:** 06/21/2019
- **Last updated:** 11/01/2024