Basic Information
| Provider Information | |||||||||
| NPI: | 1033142294 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL SPORTSCARE & REHAB, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 FAIRFAX DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222031762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035221060 | ||||||||
| FaxNumber: | 7035221080 | ||||||||
| Practice Location | |||||||||
| Address1: | 2987 PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | DUNKIRK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207542735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192582714 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 03/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | PEARSON | ||||||||
| AuthorizedOfficialFirstName: | PENNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | RCM | ||||||||
| AuthorizedOfficialTelephone: | 4432254492 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.