NPIMap

Organization Active NPI

Glen Burnie PT & Sportscare, LLC

Doing business as Pivot Physical Therapy

  • Physical Therapist
  • Pasadena, MD
National Provider Identifier
1184179202
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
GLEN BURNIE PT & SPORTSCARE, LLC
Doing business as
Pivot Physical Therapy
Practice address
3708 Mountain Rd
Ste D
Pasadena, MD 21122-2025
Phone
(410) 255-4833
NPI assigned
Aug 18, 2016
Last updated
May 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tasheda Broughton, PESC
Title
Manager, Credentialing
Phone
(252) 248-3313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

3708 Mountain Rd
Ste D
Pasadena, MD 21122-2025

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (252) 248-3313

Other names 1

  • PIVOT PHYSICAL THERAPY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Glen Burnie Physical Therapy Sportscare LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1184179202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "252-248-3313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3708 MOUNTAIN RD",
            "address_2": "STE D",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211222025",
            "telephone_number": "410-255-4833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN BURNIE PT & SPORTSCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-18",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "BROUGHTON",
        "authorized_official_first_name": "TASHEDA",
        "authorized_official_title_or_position": "MANAGER, CREDENTIALING",
        "authorized_official_telephone_number": "252-248-3313",
        "authorized_official_credential": "PESC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PIVOT PHYSICAL THERAPY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PIVOT PHYSICAL THERAPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.