Provider Demographics
NPI:1659331544
Name:ORTHOPEDIC SPORTS & REHABILITATION CENTER
Entity Type:Organization
Organization Name:ORTHOPEDIC SPORTS & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SICILIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:954-252-6014
Mailing Address - Street 1:5856 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3238
Mailing Address - Country:US
Mailing Address - Phone:954-252-6014
Mailing Address - Fax:954-252-6015
Practice Address - Street 1:5856 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-3238
Practice Address - Country:US
Practice Address - Phone:954-252-6014
Practice Address - Fax:954-252-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty