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General NPI Number Information
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NPI Number | 1912191859
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Entity Type | Organization
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Legal Business Name | SPORTS SPINE OCCUPATIONAL REHABILITATION INC
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 7015 BERACASA WAY STE 102
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City | BOCA RATON
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State | FL
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Zip | 33433-3453
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Country | US
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Telephone | 561-295-3900
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Fax | 561-431-8288
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Provider Business Mailing Address
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Address Line | 10637 MENDOCINO LN
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City | BOCA RATON
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State | FL
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Zip | 33428-1229
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Country | US
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Telephone | 561-852-8636
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Fax | 561-852-8672
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN TARRASH
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Credential | MD
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Telephone | 561-852-8636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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