# MANUAL PT & SPORTS MEDICINE

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

## Provider details

- **NPI number:** 1952300436
- **Authorized official:** MS. SUSAN ELIZABETH ROVNAK PHYSICAL THERAPIST (CEO)
- **Authorized official phone:** (410) 889-8004

## Contact information

- **Practice address:** 3612 FALLS RD LOWR LEVEL, BALTIMORE, MD 21211-1814
- **Practice address phone:** (410) 889-8004
- **Practice address fax:** (410) 889-8024
- **Mailing address:** PO BOX 50105, BALTIMORE, MD 21211-4105
- **Mailing address phone:** (410) 889-8004
- **Mailing address fax:** (410) 889-8024

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 16168 | MD | Yes |

## Other

- **Enumeration date:** 07/18/2005
- **Last updated:** 02/28/2008