Provider Demographics
NPI:1730397076
Name:PHYSICAL & SPORTS THERAPY CENTER, INC
Entity type:Organization
Organization Name:PHYSICAL & SPORTS THERAPY CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMEDES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-824-9292
Mailing Address - Street 1:7480 FAIRWAY DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6879
Mailing Address - Country:US
Mailing Address - Phone:305-824-9292
Mailing Address - Fax:305-824-0033
Practice Address - Street 1:7480 FAIRWAY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6879
Practice Address - Country:US
Practice Address - Phone:305-824-9292
Practice Address - Fax:305-824-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2508261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY915NOtherBLUECROSS BLUESHIELD