Organization
THE THERAPIST SPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFONSO GONZALEZ (PRESIDENT)
(305) 801-4030
Entity
Organization
Contact information
Practice address
14750 NW 77TH CT STE 304B, MIAMI LAKES, FL 33016-1537
(305) 801-4030
Mailing address
14750 NW 77TH CT STE 304B, MIAMI LAKES, FL 33016-1537
(305) 801-4030
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
273Y00000X
Rehabilitation Hospital Unit
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
04/18/2025
Last updated
04/18/2025
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