Provider Demographics
NPI:1255944708
Name:ORTHO SPORTS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ORTHO SPORTS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/STAFF PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGARDUY SUSTACHA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:786-223-7410
Mailing Address - Street 1:7180 E LAGO DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6512
Mailing Address - Country:US
Mailing Address - Phone:786-223-7410
Mailing Address - Fax:
Practice Address - Street 1:11205 S DIXIE HWY STE 101
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-4447
Practice Address - Country:US
Practice Address - Phone:786-223-7410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy