Provider Demographics
NPI:1447753942
Name:SPORTS AND ORTHOPEDIC CENTER, PA
Entity Type:Organization
Organization Name:SPORTS AND ORTHOPEDIC CENTER, PA
Other - Org Name:WALK-IN ORTHOPEDICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-314-7200
Mailing Address - Street 1:6280 W SAMPLE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3173
Mailing Address - Country:US
Mailing Address - Phone:954-481-9942
Mailing Address - Fax:
Practice Address - Street 1:4705 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5135
Practice Address - Country:US
Practice Address - Phone:561-220-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty