Organization
MARYLAND SPORTSCARE & REHAB, LLC
Active
Other names
PIVOT PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEDA BROUGHTON PESC (CREDENTIALING, MANAGER)
(252) 248-3313
Entity
Organization
Contact information
Practice address
7080 DEEPAGE DR, COLUMBIA, MD 21045-5219
(410) 381-7000
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(252) 248-3313
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
09/09/2016
Last updated
11/01/2024
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