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General NPI Number Information
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NPI Number | 1811504608
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Entity Type | Organization
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Legal Business Name | STRIVE SPORTS MEDICINE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 04/10/2022
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Provider Practice Location Address
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Address Line | 206 N FRUITLAND BLVD
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City | FRUITLAND
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State | MD
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Zip | 21826-1717
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Country | US
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Telephone | 410-324-3301
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Fax | 443-775-7728
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Provider Business Mailing Address
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Address Line | PO BOX 475
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City | FRUITLAND
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State | MD
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Zip | 21826-0475
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Country | US
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Telephone | 410-324-3301
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Fax | 443-775-7728
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRAVIS JAMES LIGHT
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Credential | PT
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Telephone | 443-370-2106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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