NPIMap

Organization Active NPI

Glen Burnie Physical Therapy & Sportscare, LLC

Doing business as Pivot Physical Therapy of Greater Baltimore

  • Physical Therapist
  • Columbia, MD
National Provider Identifier
1417319211
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
GLEN BURNIE PHYSICAL THERAPY & SPORTSCARE, LLC
Doing business as
Pivot Physical Therapy of Greater Baltimore
Practice address
8890 Centre Park Dr
Suite 400
Columbia, MD 21045-2188
Phone
(410) 884-6000
NPI assigned
Mar 22, 2016
Last updated
Nov 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X

Addresses

Primary practice location

8890 Centre Park Dr
Suite 400
Columbia, MD 21045-2188

Mailing address

2122 York Rd Ste 500
Oak Brook, IL 60523-1930
Phone (252) 248-3313

Other names 1

  • PIVOT PHYSICAL THERAPY OF GREATER BALTIMORE Doing business as

National Provider Directory

National Provider Directory

Locations

2122 York Rd
Ste 500
Oak Brook, IL 60523

14700 Baltimore Ave
Unit 106
Laurel, MD 20707
Phone (240) 754-2203

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1417319211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 500",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231930",
            "telephone_number": "252-248-3313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8890 CENTRE PARK DR",
            "address_2": "SUITE 400",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452188",
            "telephone_number": "410-884-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN BURNIE PHYSICAL THERAPY & SPORTSCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "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
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PIVOT PHYSICAL THERAPY OF GREATER BALTIMORE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PIVOT PHYSICAL THERAPY OF GREATER BALTIMORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.