Provider Demographics
NPI:1538955281
Name:THE THERAPIST SPORT LLC
Entity type:Organization
Organization Name:THE THERAPIST SPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-801-4030
Mailing Address - Street 1:14750 NW 77TH CT STE 304B
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1537
Mailing Address - Country:US
Mailing Address - Phone:305-801-4030
Mailing Address - Fax:
Practice Address - Street 1:14750 NW 77TH CT STE 304B
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1537
Practice Address - Country:US
Practice Address - Phone:305-801-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No273Y00000XHospital UnitsRehabilitation UnitGroup - Single Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies