NPIMap

Organization Active NPI

Glen Burnie Physical Therapy & Sportscare, LLC

Doing business as Pivot Physical Therapy of Greater Baltimore

  • Physical Therapist
  • Pasadena, MD
National Provider Identifier
1922462365
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
3708 Mountain Rd Ste D
Pasadena, MD 21122-2025
Phone
(410) 255-4833
Fax
(410) 255-4834
NPI assigned
Apr 12, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU 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) 248-3133

Other names 1

  • PIVOT PHYSICAL THERAPY OF GREATER BALTIMORE 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.

Locations

3708 Mountain Rd
Ste D
Pasadena, MD 21122
Phone (410) 255-4833

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1922462365",
    "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": "252-248-3133",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3708 MOUNTAIN RD STE D",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211222025",
            "telephone_number": "410-255-4833",
            "fax_number": "410-255-4834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN BURNIE PHYSICAL THERAPY & SPORTSCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-12",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "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 Pasadena, 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.