NPIMap

Organization Active NPI

Sports Pro Physical Therapy LLC.

  • Physical Therapist
  • Glenn Dale, MD
National Provider Identifier
1932576378
Registry record updated Sep 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SPORTS PRO PHYSICAL THERAPY LLC.
Practice address
12200 Annapolis Rd
#119
Glenn Dale, MD 20769-9182
Phone
(301) 805-5006
Fax
(301) 805-5004
NPI assigned
Sep 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2015

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

Authorized official

Name
Mr. Daryl Andrew Clarke, PTNPI 1689709719
Title
Owner
Phone
(301) 805-5006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X MD Primary

Addresses

Primary practice location

12200 Annapolis Rd
#119
Glenn Dale, MD 20769-9182

Mailing address

12200 Annapolis Rd
#119
Glenn Dale, MD 20769-9182
Phone (301) 805-5006

National Provider Directory

National Provider Directory
Tax ID family
Sports Pro Phys Therapy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

12200 Annapolis Rd
Ste 119
Glenn Dale, MD 20769
Phone (301) 805-5006

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441065600000",
    "number": "1932576378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12200 ANNAPOLIS RD",
            "address_2": "#119",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699182",
            "telephone_number": "301-805-5006",
            "fax_number": "301-805-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 ANNAPOLIS RD",
            "address_2": "#119",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699182",
            "telephone_number": "301-805-5006",
            "fax_number": "301-805-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS PRO PHYSICAL THERAPY LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-01",
        "last_updated": "2015-09-01",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "DARYL",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-805-5006",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenn Dale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; 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.