Healthcare Provider Details

I. General information

NPI: 1205906880
Provider Name (Legal Business Name): SPORTFIT REHAB & TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S. BISCAYNE BLVD SUITE 0014
MIAMI FL
33131
US

IV. Provider business mailing address

2 S BISCAYNE BLVD SUITE 0014
MIAMI FL
33131
US

V. Phone/Fax

Practice location:
  • Phone: 305-319-0073
  • Fax: 305-913-3141
Mailing address:
  • Phone: 305-206-3787
  • Fax: 305-381-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT7291
License Number StateFL

VIII. Authorized Official

Name: MRS. LISA M KEARNS
Title or Position: PHYSICAL THERAPIST
Credential: MS, PT, CSCS
Phone: 305-319-0073