1205992971 NPI number — MARYLAND SPORTSCARE & REHABILITATION OF SALISBURY, LLC

Table of content: (NPI 1205992971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205992971 NPI number — MARYLAND SPORTSCARE & REHABILITATION OF SALISBURY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND SPORTSCARE & REHABILITATION OF SALISBURY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205992971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
732 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-5037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-260-3050
Provider Business Mailing Address Fax Number:
443-260-3051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
732 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-260-3050
Provider Business Practice Location Address Fax Number:
443-260-3051
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOVIENE
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
410-829-5647

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LV43 . This is a "BC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F106 . This is a "BCHOICE-FEDERAL #" identifier . This identifiers is of the category "OTHER".




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