Healthcare Provider Details

I. General information

NPI: 1730397076
Provider Name (Legal Business Name): PHYSICAL & SPORTS THERAPY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7480 FAIRWAY DR SUITE 204
MIAMI LAKES FL
33014-6879
US

IV. Provider business mailing address

7480 FAIRWAY DR SUITE 204
MIAMI LAKES FL
33014-6879
US

V. Phone/Fax

Practice location:
  • Phone: 305-824-9292
  • Fax: 305-824-0033
Mailing address:
  • Phone: 305-824-9292
  • Fax: 305-824-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberPT2508
License Number StateFL

VIII. Authorized Official

Name: MRS. NIKE ADAMEDES
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 305-824-9292