Provider Demographics
NPI:1356376826
Name:DIAGNOSTIC SPORTS AND REHABILITATION MEDICINE, P. A.
Entity type:Organization
Organization Name:DIAGNOSTIC SPORTS AND REHABILITATION MEDICINE, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:407-574-8686
Mailing Address - Street 1:600 PALM SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7870
Mailing Address - Country:US
Mailing Address - Phone:407-574-8686
Mailing Address - Fax:407-574-3529
Practice Address - Street 1:600 PALM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7870
Practice Address - Country:US
Practice Address - Phone:407-574-8686
Practice Address - Fax:407-574-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0603098208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52004AMedicare ID - Type Unspecified