Provider Demographics
NPI:1336466671
Name:SPORTSCARE INSTITUTE, LLC
Entity Type:Organization
Organization Name:SPORTSCARE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANTIGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-887-9000
Mailing Address - Street 1:P.O. BOX 2265
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790
Mailing Address - Country:US
Mailing Address - Phone:407-960-2806
Mailing Address - Fax:
Practice Address - Street 1:231 N NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3117
Practice Address - Country:US
Practice Address - Phone:407-599-3700
Practice Address - Fax:407-599-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLET938AMedicare PIN