Healthcare Provider Details

I. General information

NPI: 1700791878
Provider Name (Legal Business Name): SPORTPERFORM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N HIGHWAY A1A STE C107
JUPITER FL
33477-4565
US

IV. Provider business mailing address

5814 STONEWOOD CT
JUPITER FL
33458-7934
US

V. Phone/Fax

Practice location:
  • Phone: 561-320-1440
  • Fax:
Mailing address:
  • Phone: 561-320-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT PORTER
Title or Position: OWNER
Credential: PT, DPT, ATC, CSCS
Phone: 561-320-1440