in - Sports

- NPI 1992855472

is a Sports in , . practices all healthcare services and medical treatments related to Sports. The NPI Number for is 1992855472. The last update date is .

's current location address is , , . You can contact this provider via phone number . The mailing address for is , , . To know further, please read the information below!

Provider Profile Detail

Provider Name
Address	, ,
Phone Number
Fax Number
Sole Proprietor	--
Credentials	--

NPI Number Detail

NPI Number	1992855472
Provider Enumeration Date
Last Updated Date

Provider Mailing Address Detail

Address
City
State	()
Post Code
Phone Number
Fax Number

Provider's Primary Taxonomy Detail

Speciality	Sports
Taxonomy	2251S0007X
Licence No	PT13484
Definition: A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Sports Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology, movement science, patholog

Provider's Other Legacy Identifiers

Identifier	Identifier Type	Identifier State	Identifier Issuer
Y7434		FL	INDIVIDUAL BLUE CROSS

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