| Active Life & Sports Therapy Llc | |
|
4337 Ebenezer Rd, Nottingham, MD 21236-2143 | |
| (410) 529-3303 | |
| (410) 529-7980 |
| Full Name | Active Life & Sports Therapy Llc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 4337 Ebenezer Rd, Nottingham, Maryland |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396836052 | NPI | - | NPPES |
| 6400507 | Other | MD | AARP |
| KCH3AC | Other | MD | CAREFIRST OF MD |
| DA1789 | Other | MD | RAILROAD MEDICARE |
| F517 | Other | MD | GHMSI |
| 434M | Other | MD | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 15366 (Maryland) | Primary |
| Provider Name | Michael D Wah |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1730271420 PECOS PAC ID: 4486640216 Enrollment ID: I20040426001859 |
| Provider Name | John J Nietubicz |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1669499158 PECOS PAC ID: 0648232009 Enrollment ID: I20041028000981 |
| Provider Name | Ellen M Hangen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1770674418 PECOS PAC ID: 3476519794 Enrollment ID: I20041208000108 |
| Provider Name | Jordan C Altekruse |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1619105038 PECOS PAC ID: 6305998840 Enrollment ID: I20090715000162 |
| Provider Name | Joseph R Palmer |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1982992467 PECOS PAC ID: 4789854548 Enrollment ID: I20110902000610 |
| Provider Name | Stephanie L Alderson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1154677003 PECOS PAC ID: 2062668668 Enrollment ID: I20120815000130 |
| Provider Name | Christina M. Penny |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1013262799 PECOS PAC ID: 3779739123 Enrollment ID: I20120820000077 |
| Provider Name | James Neal Hicks |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1417387549 PECOS PAC ID: 4981834199 Enrollment ID: I20140310001400 |
| Provider Name | Ian Lawrence Sikora |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1700213063 PECOS PAC ID: 6406079680 Enrollment ID: I20140515000077 |
| Provider Name | Michael Foley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407402936 PECOS PAC ID: 2567791262 Enrollment ID: I20190905001354 |
| Provider Name | Deidre C Cwian |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1255707691 PECOS PAC ID: 6002123718 Enrollment ID: I20200826002349 |
| Provider Name | Nihal David Studden |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598377293 PECOS PAC ID: 9830517788 Enrollment ID: I20200909003440 |
| Provider Name | Mariah E Torbit |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497486062 PECOS PAC ID: 7810377140 Enrollment ID: I20220705002079 |
| Provider Name | Rachel M Henderson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1922871755 PECOS PAC ID: 8628426624 Enrollment ID: I20231201001454 |
| Provider Name | Georgeiana B Finney |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1194556811 PECOS PAC ID: 1153869250 Enrollment ID: I20240821000078 |
| Mailing Address | Practice Location Address |
|---|---|
| Active Life & Sports Therapy Llc 4 Dulaney Gate Ct, Cockeysville, MD 21030-3011 Ph: (410) 529-3303 | Active Life & Sports Therapy Llc 4337 Ebenezer Rd, Nottingham, MD 21236-2143 Ph: (410) 529-3303 |
Nathan Dixon Mcclain, Physical Therapist Medicare: Medicare Enrolled Practice Location: 4924 Campbell Blvd Ste 130a, Nottingham, MD 21236 Phone: 443-442-2800 | |
Beverly G. Flores, Physical Therapist Medicare: Medicare Enrolled Practice Location: 4155 Glen Park Rd, Nottingham, MD 21236 Phone: 410-529-0348 | |
Jasmin Eusebio, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 4940 Campbell Blvd, Nottingham, MD 21236 Phone: 352-732-5590 | |
Erika Sachiko Takahashi, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 8019 Corporate Dr, Unit A, Nottingham, MD 21236 Phone: 410-933-7628 | |
Leonilo Fajardo Pallasigui, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 4223 Chapel Rd Apt 201, Nottingham, MD 21236 Phone: 443-301-3422 | |
Dr. Hannah Marie Vaca, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 4924 Campbell Blvd, Nottingham, MD 21236 Phone: 410-955-5000 | |
Nicole Christine Sandruck, Physical Therapist Medicare: Medicare Enrolled Practice Location: 7629 Belair Rd, Nottingham, MD 21236 Phone: 410-870-2104 |