Active Life & Sports Therapy LLC
Organization Active NPI Physical Therapist · Nottingham, MD
NPI 1396836052 · NPPES record last updated Mar 11, 2026
Key facts
- NPI
- 1396836052
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- 15366 (MD)
- Legal business name
- ACTIVE LIFE & SPORTS THERAPY LLC
- Practice address
- 4337 Ebenezer Rd
Nottingham, MD 21236-2143 - Phone
- (410) 529-3303
- Fax
- (410) 529-7980
- NPI assigned
- Sep 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Joseph Palmer
- Title
- Owner, President
- Phone
- (410) 949-6639
Practitioners 17
-
Georgiana Finney, DPT
-
Michael C Foley, DPT
-
Ellen M Hangen, PT
-
Rachel Henderson, DPT
-
James Neal Hicks Jr., DPT
-
Kenneth Jana Nolasco, PT, DPT
-
Joseph Ryan Palmer, DPT
-
Ian Lawrence Sikora, P.T., D.P.T.
-
John J Nietubicz, P.T., M.T.C.
-
Christina Marie Penny, P.T., D.P.T.
-
Jordan C Altekruse, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040426000291 | MD | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 5193711927 |
Receives reassigned benefits from 13 practitioners Practice locations: Nottingham, MD |
National Provider Directory
Locations
4337 Ebenezer Rd
Nottingham, MD 21236
Phone (410) 529-3003
9638 Belair Rd
Nottingham, MD 21236
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | 15366 | MD | Yes |
Addresses
Primary practice location
4337 Ebenezer Rd
Nottingham, MD 21236-2143
Mailing address
4337 Ebenezer Rd
Nottingham, MD 21236-2143
Phone (410) 529-3303
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6400507 | Other | MD | AARP |
| KCH3AC | Other | MD | CAREFIRST OF MD |
| DA1789 | Other | MD | RAILROAD MEDICARE |
| F517 | Other | MD | GHMSI |
| 434M | Other | MD | MEDICARE PTAN |
Other providers in Nottingham, MD
- Abpol a Bigger Perspective on Life
- Abundant Life Chiropractic, P.C.
- Michele Acevedo
- Acri Dermatology, P.a.
- Acti-Kare
- Selamawit Addissie
- Ahmed Adetola
- James Stephen Adleberg
- Shona Adleberg
- Advanced Pain Management Specialists LLC
All providers in Nottingham, MD · Physical Therapist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.