Healthcare Provider Details

I. General information

NPI: 1972741932
Provider Name (Legal Business Name): ADVANCED SPORTS MEDICINE & WELLNESS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 W 51ST ST
MIAMI BEACH FL
33140-2615
US

IV. Provider business mailing address

712 W 51ST ST
MIAMI BEACH FL
33140-2615
US

V. Phone/Fax

Practice location:
  • Phone: 305-868-7370
  • Fax: 305-868-6245
Mailing address:
  • Phone: 305-868-7370
  • Fax: 305-868-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number404769-2
License Number StateFL

VIII. Authorized Official

Name: MRS. KAREE SCHMIDT
Title or Position: ACCOUNTING ADMINISTRATOR
Credential:
Phone: 281-745-5063