Organization
SPORTSEDGE PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERNELL HAMILTON (CREDENTIALING SPECIALIST)
(954) 451-3008
Entity
Organization
Contact information
Practice address
2825 N STATE ROAD 7 STE 204, MARGATE, FL 33063-5737
(954) 451-3002
Mailing address
PO BOX 11147, FORT LAUDERDALE, FL 33339-1147
(954) 451-3002
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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