Provider Demographics
NPI:1780076695
Name:BOCA SPORTS THERAPY INC
Entity type:Organization
Organization Name:BOCA SPORTS THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-347-6682
Mailing Address - Street 1:851 MEADOWS RD
Mailing Address - Street 2:STE 212
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2348
Mailing Address - Country:US
Mailing Address - Phone:561-347-6682
Mailing Address - Fax:
Practice Address - Street 1:851 MEADOWS RD
Practice Address - Street 2:STE 212
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2348
Practice Address - Country:US
Practice Address - Phone:561-347-6682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty