Provider Demographics
NPI:1851424725
Name:SPORTS MEDICINE & REHABILITATION
Entity Type:Organization
Organization Name:SPORTS MEDICINE & REHABILITATION
Other - Org Name:SMART PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:703-501-2349
Mailing Address - Street 1:155 RIVERWAY DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2634
Mailing Address - Country:US
Mailing Address - Phone:703-501-2349
Mailing Address - Fax:
Practice Address - Street 1:155 RIVERWAY DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2634
Practice Address - Country:US
Practice Address - Phone:703-501-2349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01871Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER