Provider Demographics
NPI:1639700370
Name:USA SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:USA SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-935-9599
Mailing Address - Street 1:404 WASHINGTON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6651
Mailing Address - Country:US
Mailing Address - Phone:305-395-9599
Mailing Address - Fax:305-932-5612
Practice Address - Street 1:404 WASHINGTON AVE STE 120
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6651
Practice Address - Country:US
Practice Address - Phone:305-395-9599
Practice Address - Fax:305-932-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty