Provider Demographics
NPI:1417034752
Name:SPORTSMEDIC
Entity Type:Organization
Organization Name:SPORTSMEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-671-9200
Mailing Address - Street 1:1650 FORT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2041
Mailing Address - Country:US
Mailing Address - Phone:734-671-9200
Mailing Address - Fax:
Practice Address - Street 1:1650 FORT ST
Practice Address - Street 2:SUITE A
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2041
Practice Address - Country:US
Practice Address - Phone:734-671-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy