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General NPI Number Information
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NPI Number | 1134433980
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Entity Type | Organization
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Legal Business Name | SPORTSPAIN & SPINAL REHAB INC.
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 2500 RHODE ISLAND AVE
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City | FORT PIERCE
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State | FL
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Zip | 34947-4771
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Country | US
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Telephone | 772-489-4001
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Fax | 772-489-8411
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Provider Business Mailing Address
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Address Line | PO BOX 30277
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33420-0277
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Country | US
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Telephone | 772-489-4001
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Fax | 772-489-8411
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MUKESH D. BHATT
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Credential |
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Telephone | 772-489-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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