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
1679630073
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
5500 Knoll North Dr Ste 150
Columbia, MD 21045-2476
Phone
(443) 542-0062
Fax
(443) 542-0250
NPI assigned
Jan 3, 2007
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
Title
Credentialing Manager
Phone
(252) 248-3313

Specialties & licenses 2

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

Addresses

Primary practice location

5500 Knoll North Dr Ste 150
Columbia, MD 21045-2476

Mailing address

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

Other names 2

  • Pivot Physical Therapy of Greater Baltimore Doing business as
  • Pasadena Glen Burnie PT Offices Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040329000584 MD Part B Supplier - Clinic/Group Practice 0042102592 Receives reassigned benefits from 61 practitioners
Practice locations: Annapolis, MD; Arnold, MD; Columbia, MD; Glen Burnie, MD; Pasadena, MD
O20150901000056 DC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0042102592 Receives reassigned benefits from 44 practitioners
Practice locations: Laurel, MD

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.

Locations

1460 Ritchie Hwy
Ste 113
Arnold, MD 21012
Phone (410) 626-8350

5500 Knoll North Dr
Ste 150
Columbia, MD 21045
Phone (443) 542-0062

8890 Centre Park Dr
Ste 400
Columbia, MD 21045
Phone (410) 884-6000

Practitioners & affiliated clinicians

Practitioners 69

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 69

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1679630073",
    "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",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 KNOLL NORTH DR STE 150",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452476",
            "telephone_number": "443-542-0062",
            "fax_number": "443-542-0250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN BURNIE PHYSICAL THERAPY & SPORTSCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "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": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "252-248-3313"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pivot Physical Therapy of Greater Baltimore",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pasadena Glen Burnie PT Offices",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Pasadena Glen Burnie PT Offices",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.