| Sports Pro Physical Therapy Llc | |
|
9440 Pennsylvania Ave, # 215, Upper Marlboro, MD 20772 | |
| (301) 599-8899 | |
| (301) 599-8878 |
| Full Name | Sports Pro Physical Therapy Llc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 9440 Pennsylvania Ave, Upper Marlboro, Maryland |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285611608 | NPI | - | NPPES |
| 68640202 | Other | PROVIDER CAREFIRST BLUECR | |
| 7910288 | Other | AETNA PPO | |
| H853001 | Other | CAREFIRST BLUE CROSS BLUE | |
| 2320527 | Other | UNITED HEALTHCARE MID ATL | |
| 270001084 | Other | CORVEL | |
| 466223 | Other | MAMSI PROVIDER NUMBER | |
| 523780 | Other | NCPPO PROVIDER | |
| KER3SP | Other | GRP CAREFIRST BLUE CROSS | |
| 101837200 | Other | DOL OWCP | |
| 3204256 | Other | AETNA HMO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 18090 (Maryland) | Primary |
| 225100000X | Physical Therapist | 2800 (District Of Columbia) | Secondary |
| Provider Name | Daryl Andrew Clarke |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1689709719 PECOS PAC ID: 2163596677 Enrollment ID: I20080801000060 |
| Provider Name | Sherri Crable |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891042578 PECOS PAC ID: 3274783964 Enrollment ID: I20121015000265 |
| Provider Name | Angela R. Richards |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1205891595 PECOS PAC ID: 5496803306 Enrollment ID: I20130815000064 |
| Provider Name | Christine Dever |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568883874 PECOS PAC ID: 7719117266 Enrollment ID: I20140228000214 |
| Provider Name | Nikisha D Gandhi |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1629317201 PECOS PAC ID: 7012295108 Enrollment ID: I20161025000068 |
| Provider Name | Ketaki Jairaj Jatar |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1932613106 PECOS PAC ID: 5597024869 Enrollment ID: I20180111002056 |
| Provider Name | Wondwossen Mekbib |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1811439797 PECOS PAC ID: 3375802572 Enrollment ID: I20180116001463 |
| Provider Name | Rachael Omole |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1104330208 PECOS PAC ID: 3678833365 Enrollment ID: I20180126001363 |
| Provider Name | Kenny Gaston |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1205302973 PECOS PAC ID: 4284064445 Enrollment ID: I20200501000060 |
| Provider Name | Ketki Ajit Raktavan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1992303820 PECOS PAC ID: 2668892944 Enrollment ID: I20201027000759 |
| Mailing Address | Practice Location Address |
|---|---|
| Sports Pro Physical Therapy Llc 12200 Annapolis Rd, #119, Glenn Dale, MD 20769-9182 Ph: (301) 599-8899 | Sports Pro Physical Therapy Llc 9440 Pennsylvania Ave, # 215, Upper Marlboro, MD 20772 Ph: (301) 599-8899 |
Adeolu Tolulope Kehinde, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 10666 Campus Way S, Upper Marlboro, MD 20774 Phone: 240-492-0643 Fax: 301-778-1927 | |
Juanita Pughsley, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 10809 Kingsmere Ct, Upper Marlboro, MD 20774 Phone: 301-336-3092 | |
Raneika Shirrelle Bean, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 9440 Pennsylvania Ave, 215, Upper Marlboro, MD 20772 Phone: 301-599-8899 | |
Ms. Pamela C Hairston, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 14021 Reverend Boucher Pl, Upper Marlboro, MD 20772 Phone: 301-627-1823 | |
Dr. Revenda Greene, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1208 Canvasback Ct, Upper Marlboro, MD 20774 Phone: 301-266-9758 | |
Rein Remedy Llc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 16900 Claggett Landing Rd, Upper Marlboro, MD 20774 Phone: 443-867-2979 | |
Ms. Renee M. Riley, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1401 Mercantile Lane, Suite 107, Upper Marlboro, MD 20774 Phone: 301-658-6881 Fax: 301-322-2193 |