Healthcare Provider Details

I. General information

NPI: 1972756641
Provider Name (Legal Business Name): SPORTS AND ORTHOPEDIC REHABILITATION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22415 US HIGHWAY 27
LAKE WALES FL
33859-6861
US

IV. Provider business mailing address

4714 GETTYSBURG RD
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 863-676-5028
  • Fax:
Mailing address:
  • Phone: 717-972-1100
  • Fax: 717-975-9981

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: JOHN F DUGGAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1100