Provider Demographics
NPI:1093297384
Name:MED THERAPY & SPA, INC.
Entity Type:Organization
Organization Name:MED THERAPY & SPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SARDINA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-308-0181
Mailing Address - Street 1:7241 SW 63RD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4838
Mailing Address - Country:US
Mailing Address - Phone:305-859-0099
Mailing Address - Fax:305-422-1299
Practice Address - Street 1:7241 SW 63RD AVE STE 201
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4838
Practice Address - Country:US
Practice Address - Phone:305-859-0099
Practice Address - Fax:305-422-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty