Provider Demographics
NPI:1134433980
Name:SPORTSPAIN & SPINAL REHAB INC.
Entity type:Organization
Organization Name:SPORTSPAIN & SPINAL REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-489-4001
Mailing Address - Street 1:PO BOX 30277
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-0277
Mailing Address - Country:US
Mailing Address - Phone:772-489-4001
Mailing Address - Fax:772-489-8411
Practice Address - Street 1:2500 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4771
Practice Address - Country:US
Practice Address - Phone:772-489-4001
Practice Address - Fax:772-489-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty