Organization
MARYLAND SPORTSCARE & REHAB, LLC
Active
Other names
PIVOT PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
(252) 248-3313
Entity
Organization
Contact information
Practice address
5435 BEAVERKILL RD, COLUMBIA, MD 21044
(410) 740-0883
Mailing address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 258-2714
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
09/09/2016
Last updated
11/01/2024
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