Provider Demographics
NPI:1841152501
Name:LEGACY SPORTS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:LEGACY SPORTS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:240-520-8307
Mailing Address - Street 1:113 EASTWIND LN
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2911
Mailing Address - Country:US
Mailing Address - Phone:240-520-8307
Mailing Address - Fax:
Practice Address - Street 1:7307 SANDSCOVE CT STE 11
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5902
Practice Address - Country:US
Practice Address - Phone:407-536-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty