Active NPI
Sports Pro Physical Therapy South LLC
- Physical Therapist
- Fort Washington, MD
National Provider Identifier
1124438700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 18090
- Legal business name
- SPORTS PRO PHYSICAL THERAPY SOUTH LLC
- Practice address
- 930 E Swan Creek Rd
Fort Washington, MD 20744-5250 - Phone
- (301) 805-5006
- Fax
- (301) 805-5004
- NPI assigned
- May 5, 2014
- Organization subpart
- Yes
- Parent organization
- SPORTS PRO PHYSICAL THERAPY LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Daryl Andrew Clarke, PT
- Title
- Owner
- Phone
- (301) 805-5006
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 18090 | MD | Primary |
Addresses
Primary practice location
930 E Swan Creek Rd
Fort Washington, MD 20744-5250
Mailing address
930 E Swan Creek Rd
Fort Washington, MD 20744-5250
Phone (301) 805-5006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
National Provider Directory
National Provider Directory- Part of
- Sports Pro Physical Therapy
Locations
930 E Swan Creek Rd
Ft Washington, MD 20744
Phone (301) 292-9400
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399248000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1399248000000",
"number": "1124438700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "930 E SWAN CREEK RD",
"city": "FORT WASHINGTON",
"state": "MD",
"postal_code": "207445250",
"telephone_number": "301-805-5006",
"fax_number": "301-805-5004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 E SWAN CREEK RD",
"city": "FORT WASHINGTON",
"state": "MD",
"postal_code": "207445250",
"telephone_number": "301-805-5006",
"fax_number": "301-805-5004"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SPORTS PRO PHYSICAL THERAPY SOUTH LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SPORTS PRO PHYSICAL THERAPY LLC",
"enumeration_date": "2014-05-05",
"last_updated": "2014-05-05",
"status": "A",
"authorized_official_last_name": "CLARKE",
"authorized_official_first_name": "DARYL",
"authorized_official_middle_name": "ANDREW",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "301-805-5006",
"authorized_official_credential": "PT"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "MD",
"license": "18090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Washington, MD
- Monique Smith, DCN
- Belinda Davis Smith, PH.D., LCSW, PH,D,M LCSW
- George Freddie Snead Jr.
- Desiree Spencer, LICSW
- Sport & Spine Rehab of Fort Washington, LLC
- William Stinson Jr.
- Amber C Stokes, PHARMD
- Strategic Screening & Diagnostics, LLC
- Suburban Orthopaedic Total Joint and Sports Clinic, P.C.
- Suburban Orthopaedic,Total Joint and Sports Clinic,P.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.