Healthcare Provider Details

I. General information

NPI: 1306443221
Provider Name (Legal Business Name): ATHLETIX REHAB AND RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 10/04/2020
Certification Date: 10/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 GREEN RD STE DEF
DEERFIELD BEACH FL
33064-1080
US

IV. Provider business mailing address

6941 SW 63RD CT
SOUTH MIAMI FL
33143-3344
US

V. Phone/Fax

Practice location:
  • Phone: 570-574-7517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

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