Provider Demographics
NPI:1750666814
Name:INNOVATIVE SPORTS REHAB, LLC
Entity Type:Organization
Organization Name:INNOVATIVE SPORTS REHAB, LLC
Other - Org Name:INNOVATIVE SPORTS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:954-693-9090
Mailing Address - Street 1:9131 SW 22ND CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6856
Mailing Address - Country:US
Mailing Address - Phone:954-693-9090
Mailing Address - Fax:954-475-9611
Practice Address - Street 1:9131 SW 22ND CT
Practice Address - Street 2:SUITE C
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-6856
Practice Address - Country:US
Practice Address - Phone:954-693-9090
Practice Address - Fax:954-475-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-24885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty