Provider Demographics
NPI:1174262224
Name:USA SPORTS MEDICINE MIAMI LAKES LLC
Entity Type:Organization
Organization Name:USA SPORTS MEDICINE MIAMI LAKES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-479-2973
Mailing Address - Street 1:404 WASHINGTON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6651
Mailing Address - Country:US
Mailing Address - Phone:305-479-2973
Mailing Address - Fax:305-735-7662
Practice Address - Street 1:16200 NW 57TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6714
Practice Address - Country:US
Practice Address - Phone:305-479-2973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty