| Organization Name: | FREDERICK SPORT & SPINE CLINIC |
| NPI Number: | 1134397722 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CONNIE F GOODING (BILLING SPECIALIST) |
| Mailing Address: | 19 West Frederick Street Walkersville |
| State: | MD US |
| Postal Code: | 21793 |
| Phone Number: | 3016628541 |
| Fax Number: | |
| NPI Enumeration Date: | 02/15/2008 |
| NPI Last Update Date: | 02/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 17003 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |