Provider Demographics
NPI:1790798932
Name:ORTHO SPORTS INC
Entity Type:Organization
Organization Name:ORTHO SPORTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:AIKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT DIP MDT
Authorized Official - Phone:956-682-6778
Mailing Address - Street 1:4900 N 10TH STREET
Mailing Address - Street 2:STE D2
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-682-6778
Mailing Address - Fax:956-682-6998
Practice Address - Street 1:4900 N 10TH STREET
Practice Address - Street 2:STE D2
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-682-6778
Practice Address - Fax:956-682-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00464EMedicare ID - Type Unspecified