Organization
LIFEBRIDGE SPORTS MEDICINE & REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYNE FLECK POOL (CHIEF COMPLIANCE OFFICER)
(610) 884-4803
Entity
Organization
Contact information
Practice address
9712 BELAIR RD, SUITE 101, NOTTINGHAM, MD 21236-1111
(410) 256-7070
(410) 256-7077
Mailing address
PO BOX 1245, INDIANA, PA 15701-5245
(724) 465-3496
(215) 413-4682
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
07/21/2011
Last updated
04/25/2012
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