Organization
IMPACT SPORTS PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT ESBRANDT PT,DPT, PES (OWNER, PHYSICAL THERAPIST)
(410) 322-9777
Entity
Organization
Contact information
Practice address
7468 CANDLEWOOD RD, HANOVER, MD 21076-3211
(410) 684-5642
Mailing address
8816 DOVE DR, PERRY HALL, MD 21128-9000
(410) 322-9777
(443) 632-0521
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
25008
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013316884
INDIVIDUAL NPI ROBERT ESBRANDT
—
01
—
1780097113
INDIVIDUAL NPI
—
01
—
25008
MARYLAND PT LICENSE
—
01
—
W18167155
LLC ID #
—
Enumeration date
08/02/2017
Last updated
08/10/2022
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