MEDICARE: USA SPORTS THERAPY SOUTH MIAMI INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor
2	225100000X	Physical Therapist		FL

General Provider Information

NPI Number	:	1154815926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USA SPORTS THERAPY SOUTH MIAMI INC

Provider Business Mailing Address
First Line	:	21150 BISCAYNE BLVD STE 406
Second Line	:
City	:	AVENTURA
State	:	FL
Zip	:	33180-1250
Country	:	US
Telephone Number	:	305-935-9599
Fax Number	:	305-932-5612

Provider Business Practice Location Address
First Line	:	360 GRANELLO AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-1883
Country	:	US
Telephone Number	:	305-420-5682
Fax Number	:	305-932-5612

Authorized Official
Title or Position	:	AO/ OWNER/ PROVIDER
Name	:	DR. MATTHEW COPPER
Credential	:	DC
Telephone Number	:	305-935-9599

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	04/10/2026

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