Healthcare Provider Details

I. General information

NPI: 1275312092
Provider Name (Legal Business Name): USA SPORTS THERAPY FISHER ISLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 E VENICE AVE
VENICE FL
34285-7039
US

IV. Provider business mailing address

21000 NE 28TH AVE STE 104
AVENTURA FL
33180-1421
US

V. Phone/Fax

Practice location:
  • Phone: 941-412-3800
  • Fax:
Mailing address:
  • Phone: 305-935-9599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW I COOPER
Title or Position: AO/OWNER
Credential: DC
Phone: 305-935-9599