Provider Demographics
NPI:1275312092
Name:USA SPORTS THERAPY FISHER ISLAND INC
Entity Type:Organization
Organization Name:USA SPORTS THERAPY FISHER ISLAND INC
Other - Org Name:TWIN PALMS CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:AO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:I
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-935-9599
Mailing Address - Street 1:21000 NE 28TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1421
Mailing Address - Country:US
Mailing Address - Phone:305-935-9599
Mailing Address - Fax:
Practice Address - Street 1:804 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7039
Practice Address - Country:US
Practice Address - Phone:941-412-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy