Basic Information
| Provider Information | |||||||||
| NPI: | 1700030020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPY AND SPORTS CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13011 SUMMERFIELD SQUARE DR | ||||||||
| Address2: | |||||||||
| City: | RIVERVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335787402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133742209 | ||||||||
| FaxNumber: | 8133742211 | ||||||||
| Practice Location | |||||||||
| Address1: | 13011 SUMMERFIELD SQUARE DR | ||||||||
| Address2: | |||||||||
| City: | RIVERVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335787402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133742209 | ||||||||
| FaxNumber: | 8133742211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2008 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUTCHINS | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7278985001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THERAPY AND SPORTS CENTER, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Y930Y | 01 | FL | BC & BS OF FLORIDA PROVIDER NUMBER | OTHER |