Provider Demographics
NPI:1811504608
Name:STRIVE SPORTS MEDICINE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:STRIVE SPORTS MEDICINE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:443-370-2106
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-0475
Mailing Address - Country:US
Mailing Address - Phone:410-324-3301
Mailing Address - Fax:443-775-7728
Practice Address - Street 1:206 N FRUITLAND BLVD
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:MD
Practice Address - Zip Code:21826-1717
Practice Address - Country:US
Practice Address - Phone:410-324-3301
Practice Address - Fax:443-775-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty