Healthcare Provider Details

I. General information

NPI: 1578562419
Provider Name (Legal Business Name): SPORTS SPECIALTY & REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 HANCOCK BRIDGE PKWY SUITE 103
CAPE CORAL FL
33990-1459
US

IV. Provider business mailing address

2328 HANCOCK BRIDGE PKWY SUITE 103
CAPE CORAL FL
33990-1459
US

V. Phone/Fax

Practice location:
  • Phone: 239-574-7557
  • Fax: 239-574-1315
Mailing address:
  • Phone: 239-573-1518
  • Fax: 239-573-7356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name: ELKE C PRICE
Title or Position: ADMINISTRATOR
Credential:
Phone: 239-573-1518