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General NPI Number Information
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NPI Number | 1871224220
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Entity Type | Organization
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Legal Business Name | SAGE PHYSICAL THERAPY & WELLNESS, LLC
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 06/17/2022
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Provider Practice Location Address
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Address Line | 4000 OLD COURT RD STE 100
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City | PIKESVILLE
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State | MD
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Zip | 21208-2891
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Country | US
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Telephone | 410-415-0005
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Fax | 410-415-0006
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Provider Business Mailing Address
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Address Line | PO BOX 745944
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City | ATLANTA
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State | GA
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Zip | 30374-5944
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Country | US
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Telephone | 410-970-8177
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Fax | 410-313-8024
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | TODD SIGMON
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Credential |
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Telephone | 410-970-8177
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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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