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General NPI Number Information
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NPI Number | 1568997880
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE AND REHAB FITNESS
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 4405 CROOKED MILE RD
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-6310
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Country | US
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Telephone | 956-343-9244
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Fax |
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Provider Business Mailing Address
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Address Line | 727 NORTH DR STE L
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City | MELBOURNE
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State | FL
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Zip | 32934-9233
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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 | PHYSICIAN/OWNER
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Name | DR. ELIZABETH VASSER
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Credential | MD
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Telephone | 956-343-9244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | ME111472
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License Number State | FL
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