# GLEN BURNIE PHYSICAL THERAPY & SPORTSCARE, LLC

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

## Provider details

- **NPI number:** 1922462365
- **Authorized official:** TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
- **Authorized official phone:** (252) 248-3313

## Contact information

- **Practice address:** 3708 MOUNTAIN RD STE D, PASADENA, MD 21122-2025
- **Practice address phone:** (410) 255-4833
- **Practice address fax:** (410) 255-4834
- **Mailing address:** 2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
- **Mailing address phone:** (252) 248-3133
- **Mailing address fax:** (410) 648-4878

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 04/12/2016
- **Last updated:** 11/01/2024