# LIFEBRIDGE SPORTS MEDICINE & REHABILITATION LLC

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

## Provider details

- **NPI number:** 1922396100
- **Authorized official:** JAYNE FLECK POOL (CHIEF COMPLIANCE OFFICER)
- **Authorized official phone:** (610) 884-4803

## Contact information

- **Practice address:** 9712 BELAIR RD, SUITE 101, NOTTINGHAM, MD 21236-1111
- **Practice address phone:** (410) 256-7070
- **Practice address fax:** (410) 256-7077
- **Mailing address:** PO BOX 1245, INDIANA, PA 15701-5245
- **Mailing address phone:** (724) 465-3496
- **Mailing address fax:** (215) 413-4682

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/21/2011
- **Last updated:** 04/25/2012