Organization
FREDERICK SPORT & SPINE CLINIC
Active
Parent organization
FREDERICK SPORT & SPINE CLINIC
Other names
Walkersville Sport & Spine Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
FREDERICK SPORT & SPINE CLINIC
Authorized official
MS. CONNIE F GOODING (BILLING SPECIALIST)
(301) 662-8541
Entity
Organization
Contact information
Practice address
19 WEST FREDERICK STREET, WALKERSVILLE, MD 21793
(301) 662-8541
Mailing address
84 THOMAS JOHNSON CT, SUITE B, FREDERICK, MD 21702-4348
(301) 662-8541
(301) 662-8762
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
17003
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123M
MEDICARE
MD
01
—
2004876
UNITED HEALTHCARE
MD
01
—
334552
PHCS
MD
01
—
551810
MAMSI
MD
01
—
LK93FRR
CAREFIRST
MD
01
—
R559
CAREFIRST NAL'L
MD
Enumeration date
02/15/2008
Last updated
02/15/2008
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