Basic Information
| Provider Information | |||||||||
| NPI: | 1023539178 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRUE SPORTS PHYSICAL THERAPY 2, LLC | ||||||||
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| OtherOrganizationName: | TRUE SPORTS PHYSICAL THERAPY 2, LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3307 TIMBERFIELD LN | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212084425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102156621 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15870 FREDERICK RD | ||||||||
| Address2: | |||||||||
| City: | WOODBINE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217978528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102156621 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2017 | ||||||||
| LastUpdateDate: | 06/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | ROSENBLATT | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | ARON | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4102156621 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT, CSCS, OCS, | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 1622 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.