Provider Demographics
NPI:1114357340
Name:TRUE SPORTS PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:TRUE SPORTS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT-MESNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-307-9453
Mailing Address - Street 1:3307 TIMBERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4425
Mailing Address - Country:US
Mailing Address - Phone:410-215-6621
Mailing Address - Fax:
Practice Address - Street 1:710 S ANN ST FL 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3401
Practice Address - Country:US
Practice Address - Phone:410-989-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1622261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy