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General NPI Number Information
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NPI Number | 1275204083
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Entity Type | Organization
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Legal Business Name | POWER PLAY SPORTS & THERAPY LLC
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 11907 SHADOW RUN BLVD
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City | RIVERVIEW
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State | FL
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Zip | 33569
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Country | US
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Telephone | 813-374-2209
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Fax |
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Provider Business Mailing Address
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Address Line | 11705 BOYETTE RD STE 420
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City | RIVERVIEW
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State | FL
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Zip | 33569-5533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ERIC SMITH
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Credential | MPT
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Telephone | 813-374-2209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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