Provider Demographics
NPI:1386303832
Name:SPORTS MEDICINE AND ORTHOPAEDIC CENTER
Entity type:Organization
Organization Name:SPORTS MEDICINE AND ORTHOPAEDIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL PROJECTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSCITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-842-7010
Mailing Address - Street 1:501 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3843
Mailing Address - Country:US
Mailing Address - Phone:757-842-7010
Mailing Address - Fax:
Practice Address - Street 1:501 DISCOVERY DR STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3843
Practice Address - Country:US
Practice Address - Phone:757-842-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty