Healthcare Provider Details

I. General information

NPI: 1063185320
Provider Name (Legal Business Name): TRUE SPORTS PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2021
Last Update Date: 07/31/2021
Certification Date: 07/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18761 N FREDERICK AVE STE T
GAITHERSBURG MD
20879-3152
US

IV. Provider business mailing address

2240 GREENSPRING DR
TIMONIUM MD
21093-3114
US

V. Phone/Fax

Practice location:
  • Phone: 410-989-3833
  • Fax: 410-793-4579
Mailing address:
  • Phone: 410-989-3833
  • Fax: 410-793-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN A ROSENBLATT
Title or Position: OWNER
Credential: DPT
Phone: 410-989-3833