Healthcare Provider Details

I. General information

NPI: 1659331544
Provider Name (Legal Business Name): ORTHOPEDIC SPORTS & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5856 S FLAMINGO RD
COOPER CITY FL
33330-3238
US

IV. Provider business mailing address

5856 S FLAMINGO RD
COOPER CITY FL
33330-3238
US

V. Phone/Fax

Practice location:
  • Phone: 954-252-6014
  • Fax: 954-252-6015
Mailing address:
  • Phone: 954-252-6014
  • Fax: 954-252-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINA M SICILIANO
Title or Position: PRESIDENT
Credential: PTA
Phone: 954-252-6014