Provider Demographics
NPI:1770323677
Name:SPORTS AND WELLNESS PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:SPORTS AND WELLNESS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLACT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:813-605-5646
Mailing Address - Street 1:3306 S WEST SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7644
Mailing Address - Country:US
Mailing Address - Phone:813-605-5646
Mailing Address - Fax:813-605-5647
Practice Address - Street 1:3306 S WEST SHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7644
Practice Address - Country:US
Practice Address - Phone:813-605-5646
Practice Address - Fax:813-605-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy