Healthcare Provider Details

I. General information

NPI: 1841595691
Provider Name (Legal Business Name): DOWNTOWN SPORTFIT REHAB AND TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ANASTASIA AVE
CORAL GABLES FL
33134-6339
US

IV. Provider business mailing address

1172 S DIXIE HWY #530
CORAL GABLES FL
33146-2918
US

V. Phone/Fax

Practice location:
  • Phone: 305-445-8066
  • Fax: 305-913-3141
Mailing address:
  • Phone: 305-381-6223
  • Fax: 305-381-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7291
License Number StateFL

VIII. Authorized Official

Name: MS. LISA KEARNS
Title or Position: OWNER
Credential: PT
Phone: 305-206-3787