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General NPI Number Information
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NPI Number | 1609269612
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Entity Type | Organization
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Legal Business Name | TOTAL SPORTS REHAB AND PHYSICAL THERAPY OF MARYLAND LLC.
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Dates
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Enumeration Date | 03/15/2015
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Last Update Date | 03/15/2015
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Provider Practice Location Address
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Address Line | 5834 EAST AVE
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City | BALTIMORE
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State | MD
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Zip | 21206-1413
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Country | US
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Telephone | 443-798-0414
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Fax | 410-668-6612
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Provider Business Mailing Address
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Address Line | 5834 EAST AVE
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City | BALTIMORE
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State | MD
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Zip | 21206-1413
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Country | US
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Telephone | 443-798-0414
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Fax | 410-668-6612
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Authorized Official
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Title or Position | OWNER/ PHYSICAL THERAPIST
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Name | DR. DAVID GREEN
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Credential | DPT
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Telephone | 443-798-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 22267
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License Number State | MD
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