Provider Demographics
NPI:1871992040
Name:PIVOT PHYSICAL THERAPY
Entity type:Organization
Organization Name:PIVOT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ALYSSA
Authorized Official - Last Name:PIFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:215-206-6057
Mailing Address - Street 1:7407 VILLAGE RD APT 12
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7461
Mailing Address - Country:US
Mailing Address - Phone:215-206-6057
Mailing Address - Fax:
Practice Address - Street 1:1207 LIBERTY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6574
Practice Address - Country:US
Practice Address - Phone:410-549-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25150261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy