Healthcare Provider Details

I. General information

NPI: 1841026978
Provider Name (Legal Business Name): ELITE SPORTS MEDICINE AND RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8534 HERITAGE GREEN WAY
BRADENTON FL
34212
US

IV. Provider business mailing address

15510 DERNA TER
BRADENTON FL
34211-5507
US

V. Phone/Fax

Practice location:
  • Phone: 201-213-6983
  • Fax:
Mailing address:
  • Phone: 201-213-6983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINE FOSS
Title or Position: OWNER
Credential: DC
Phone: 201-213-6983