Provider Demographics
NPI:1841595691
Name:DOWNTOWN SPORTFIT REHAB AND TRAINING
Entity Type:Organization
Organization Name:DOWNTOWN SPORTFIT REHAB AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-206-3787
Mailing Address - Street 1:1172 S DIXIE HWY
Mailing Address - Street 2:#530
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2918
Mailing Address - Country:US
Mailing Address - Phone:305-381-6223
Mailing Address - Fax:305-381-6294
Practice Address - Street 1:1200 ANASTASIA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6339
Practice Address - Country:US
Practice Address - Phone:305-445-8066
Practice Address - Fax:305-913-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty