Healthcare Provider Details

I. General information

NPI: 1912838145
Provider Name (Legal Business Name): TRUE SPORTS PERFORMANCE & REHAB SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12940 W STATE ROAD 84
DAVIE FL
33325-3306
US

IV. Provider business mailing address

3414 W 110TH TER
HIALEAH FL
33018-2180
US

V. Phone/Fax

Practice location:
  • Phone: 954-546-0178
  • Fax:
Mailing address:
  • Phone: 786-583-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSE MARTIR
Title or Position: PRESIDENT
Credential: PTA
Phone: 786-583-8591