| Spine & Sports Physical Therapy & Diagnostics, Llc | |
|
1406b Crain Hwy S Suite 107 Glen Burnie MD 21061-4099 | |
| (410) 625-5050 | |
| (410) 766-1404 |
| Full Name | Spine & Sports Physical Therapy & Diagnostics, Llc |
|---|---|
| Speciality | Physical Therapist |
| Location | 1406b Crain Hwy S, Glen Burnie, Maryland |
| Authorized Official Name and Position | Charles Davis (SOLE MEMBER) |
| Authorized Official Contact | 4106255050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spine & Sports Physical Therapy & Diagnostics, Llc 1406b Crain Hwy S Suite 107 Glen Burnie MD 21061-4099 Ph: (410) 625-5050 | Spine & Sports Physical Therapy & Diagnostics, Llc 1406b Crain Hwy S Suite 107 Glen Burnie MD 21061-4099 Ph: (410) 625-5050 |
| NPI Number | 1083077499 |
|---|---|
| Provider Enumeration Date | 04/02/2016 |
| Last Update Date | 04/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083077499 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 225100000X | Physical Therapist | (* (Not Available)) | Primary |
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