Healthcare Provider Details

I. General information

NPI: 1508211475
Provider Name (Legal Business Name): SOUTH FLORIDA SPORT & MEDICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7541 W OAKLAND PARK BLVD
TAMARAC FL
33319-4909
US

IV. Provider business mailing address

7541 W OAKLAND PARK BLVD
TAMARAC FL
33319-4909
US

V. Phone/Fax

Practice location:
  • Phone: 954-459-4600
  • Fax:
Mailing address:
  • Phone: 954-459-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY HALL
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 954-459-6000