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General NPI Number Information
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NPI Number | 1083022974
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL SPORTSCARE AND REHAB
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 07/24/2014
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Provider Practice Location Address
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Address Line | 203 GRINDALL ST
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City | BALTIMORE
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State | MD
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Zip | 21230-4103
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Country | US
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Telephone | 410-884-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 203 GRINDALL ST
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City | BALTIMORE
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State | MD
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Zip | 21230-4103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPY DIRECTOR
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Name | CHAD PATTEE
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Credential |
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Telephone | 410-884-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 25MT00193100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | A00308
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License Number State | MD
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