# SPORTS AND ORTHOPEDIC CENTER PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386205599
- **Authorized official:** MANISH K GUPTA MD (OWNER)
- **Authorized official phone:** (954) 481-9942

## Contact information

- **Practice address:** 7545 W BOYNTON BEACH BLVD STE 202, BOYNTON BEACH, FL 33437-6167
- **Practice address phone:** (954) 481-9942
- **Practice address fax:** (954) 481-9917
- **Mailing address:** 6280 W SAMPLE RD STE 203, CORAL SPRINGS, FL 33067-3173
- **Mailing address phone:** (954) 481-9942
- **Mailing address fax:** (954) 481-9917

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/27/2019
- **Last updated:** 06/27/2019