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General NPI Number Information
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NPI Number | 1194032722
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Entity Type | Organization
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Legal Business Name | SPORT THERAPY SERVICES CORP.
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 7171 SW 24TH ST STE 517
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City | MIAMI
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State | FL
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Zip | 33155-1694
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Country | US
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Telephone | 305-266-5559
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Fax | 305-266-5519
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Provider Business Mailing Address
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Address Line | 7171 SW 24TH ST STE 517
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City | MIAMI
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State | FL
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Zip | 33155-1694
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Country | US
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Telephone | 305-266-5559
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Fax | 305-266-5519
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FRANCISCO DAVID DE LA CRUZ
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Credential | LMT
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Telephone | 305-266-5559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | ME31311
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License Number State | FL
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