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General NPI Number Information
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NPI Number | 1740569383
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Entity Type | Organization
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Legal Business Name | TEAM SPORTS INJURY CONSULTING, LLC
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Dates
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Enumeration Date | 08/14/2011
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Last Update Date | 08/14/2011
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Provider Practice Location Address
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Address Line | 379 FIELD HOUSE DR RM 109
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City | COLLEGE PARK
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State | MD
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Zip | 20742-0001
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Country | US
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Telephone | 240-281-6821
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Fax | 301-314-6549
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Provider Business Mailing Address
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Address Line | 9806 SPANISH OAK WAY
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City | BOWIE
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State | MD
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Zip | 20721-3716
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Country | US
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Telephone | 240-281-6821
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Fax | 301-925-4591
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Authorized Official
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Title or Position | OWNER, CLINICAL COORDINATOR
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Name | MISS KALA YVONNE FLAGG
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Credential | MPT, ATC, CSCS
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Telephone | 240-281-6821
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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 | 20046
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License Number State | MD
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