Provider Demographics
NPI:1053477935
Name:CAMBRIDGE PHYSICAL THERAPY AND SPORTS CARE, LLC
Entity type:Organization
Organization Name:CAMBRIDGE PHYSICAL THERAPY AND SPORTS CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:THROCKMORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-258-2714
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-820-4330
Practice Address - Street 1:321 DORCHESTER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2425
Practice Address - Country:US
Practice Address - Phone:410-228-5100
Practice Address - Fax:410-228-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402750700Medicaid
MD827311OtherPRIORITY PARTNERS
G540OtherBCHOICE-FED BC
MDKDE4OtherBC
G540OtherBCHOICE-FED BC