1811249055 NPI number — SPORTS AND ORTHOPEDIC SPECIALISTS PHYSICAL THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811249055 NPI number — SPORTS AND ORTHOPEDIC SPECIALISTS PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPORTS AND ORTHOPEDIC SPECIALISTS PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOSPT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811249055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8371 N MILITARY TRL
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33410-6300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-328-9298
Provider Business Mailing Address Fax Number:
561-328-9348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8371 N MILITARY TRL
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-328-9298
Provider Business Practice Location Address Fax Number:
561-328-9348
Provider Enumeration Date:
10/11/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROOKS-ANGLE
Authorized Official First Name:
KERRIE
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
561-317-4847

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT 19952 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)