Organization
MIDDLETOWN SPORT AND SPINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE GOODING (CREDENTIALING REPRESENTATIVE)
(301) 662-8541
Entity
Organization
Contact information
Practice address
205 S. CHURCH STREET, SUITE B, MIDDLETOWN, MD 21769
(301) 662-8541
(301) 662-8762
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
—
—
Other
Enumeration date
08/07/2006
Last updated
05/05/2009
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