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General NPI Number Information
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NPI Number | 1194620211
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Entity Type | Organization
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Legal Business Name | ELITE SPORTS PT LLC
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 5300 POWERLINE RD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-3172
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Country | US
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Telephone | 754-307-4107
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Fax |
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Provider Business Mailing Address
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Address Line | 11821 NW 31ST PL
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City | SUNRISE
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State | FL
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Zip | 33323-1210
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Country | US
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Telephone | 754-307-4107
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN JOHNSON
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Credential | PT, DPT, CSCS
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Telephone | 360-525-8349
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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 |
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License Number State | NULL
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