Provider Demographics
NPI:1689693848
Name:ORTHOSPORT INC.
Entity Type:Organization
Organization Name:ORTHOSPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:954-382-4343
Mailing Address - Street 1:5200 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 105-A
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5316
Mailing Address - Country:US
Mailing Address - Phone:954-382-4343
Mailing Address - Fax:954-382-4342
Practice Address - Street 1:5200 S UNIVERSITY DR
Practice Address - Street 2:SUITE 105-A
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5316
Practice Address - Country:US
Practice Address - Phone:954-382-4343
Practice Address - Fax:954-382-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 17930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLX1324Medicare ID - Type Unspecified