Healthcare Provider Details

I. General information

NPI: 1285350843
Provider Name (Legal Business Name): MEDICAL SPORTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3836 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-9413
US

IV. Provider business mailing address

3836 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-9413
US

V. Phone/Fax

Practice location:
  • Phone: 954-421-2355
  • Fax:
Mailing address:
  • Phone: 954-421-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HAROUT TCHOULHAKIAN
Title or Position: OWNER
Credential: DC
Phone: 818-749-8523