Basic Information
| Provider Information | |||||||||
| NPI: | 1871992040 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIVOT PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7407 VILLAGE RD APT 12 | ||||||||
| Address2: | |||||||||
| City: | SYKESVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217847461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152066057 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1207 LIBERTY RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | ELDERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217846574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105495700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2014 | ||||||||
| LastUpdateDate: | 08/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | PIFER | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
| AuthorizedOfficialMiddleName: | ALYSSA | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 2152066057 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 25150 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.