| Organization Name: | EVOLUTION SPORTS PHYSIOTHERAPY - WHITE MARSH, LLC |
| NPI Number: | 1134519838 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MORGAN SANDFORD JOHNSON (OWNER / PARTNET) |
| Mailing Address: | 10540 York Rd Suite F Cockeysville |
| State: | MD US |
| Postal Code: | 210302300 |
| Phone Number: | 4439553515 |
| Fax Number: | 4106280542 |
| NPI Enumeration Date: | 02/02/2015 |
| NPI Last Update Date: | 02/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 20554 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |