Provider Demographics
NPI:1609023613
Name:ALL-PRO THERAPY & SPORTS TRAINING LLC
Entity Type:Organization
Organization Name:ALL-PRO THERAPY & SPORTS TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-961-4315
Mailing Address - Street 1:1812 59TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4630
Mailing Address - Country:US
Mailing Address - Phone:941-794-3305
Mailing Address - Fax:941-792-8881
Practice Address - Street 1:1812 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4630
Practice Address - Country:US
Practice Address - Phone:941-794-3305
Practice Address - Fax:941-792-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL013473261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy