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General NPI Number Information
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NPI Number | 1750100723
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Entity Type | Organization
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Legal Business Name | PRESTIGE SPORTS AND REGENERATIVE MEDICINE LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 3800 W BROWARD BLVD STE 101
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-1018
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Country | US
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Telephone | 469-915-4211
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Fax | 954-820-4479
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Provider Business Mailing Address
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Address Line | 3800 W BROWARD BLVD STE 101
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-1018
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Country | US
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Telephone | 954-787-5234
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Fax | 954-820-4479
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | EMIR KHATTAK
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Credential |
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Telephone | 469-485-3166
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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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