Healthcare Provider Details

I. General information

NPI: 1801301015
Provider Name (Legal Business Name): ATHLETIX REHAB AND RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 S PINE ISLAND RD
DAVIE FL
33328-5933
US

IV. Provider business mailing address

60 SW 13TH ST APT 4005
MIAMI FL
33130-4358
US

V. Phone/Fax

Practice location:
  • Phone: 305-501-0231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27956
License Number StateFL

VIII. Authorized Official

Name: DR. SHARIF TABBAH
Title or Position: CO-OWNER
Credential: DPT, CSCS
Phone: 305-501-0231