Provider Demographics
NPI:1821383266
Name:ORTHOSPORT GROUP, PLLC
Entity Type:Organization
Organization Name:ORTHOSPORT GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROOKS-ANGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:561-317-4847
Mailing Address - Street 1:8371 N MILITARY TRL
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6300
Mailing Address - Country:US
Mailing Address - Phone:561-328-9298
Mailing Address - Fax:
Practice Address - Street 1:8371 N MILITARY TRL
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6300
Practice Address - Country:US
Practice Address - Phone:561-328-9298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-10-27
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
FLFK512AMedicare PIN