Healthcare Provider Details

I. General information

NPI: 1437540069
Provider Name (Legal Business Name): SPORTS MEDICINE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 TRACE DR
DELAWARE OH
43015-7059
US

IV. Provider business mailing address

481 TRACE DR
DELAWARE OH
43015-7059
US

V. Phone/Fax

Practice location:
  • Phone: 614-432-6401
  • Fax:
Mailing address:
  • Phone: 614-432-6401
  • 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: MR. MICHAEL SEAN HUFFMAN
Title or Position: PRESIDENT
Credential: PT
Phone: 614-432-6401