Healthcare Provider Details

I. General information

NPI: 1578336541
Provider Name (Legal Business Name): ASR SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 S MIAMI AVE STE 201
MIAMI FL
33130-4111
US

IV. Provider business mailing address

1106 S MIAMI AVE STE 201
MIAMI FL
33130-4111
US

V. Phone/Fax

Practice location:
  • Phone: 305-984-1155
  • Fax:
Mailing address:
  • Phone: 305-984-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC ALEXANDER
Title or Position: PRESIDENT
Credential: DPT
Phone: 305-984-1155