Organization
SPORT AND SPINE PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Active
Organization
SPORT AND SPINE PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN P WHELTON MSPT, DPT (OWNER)
(813) 948-1020
Entity
Organization
Contact information
Practice address
17824 N US HIGHWAY 41, LUTZ, FL 33549
(813) 948-1020
(813) 948-1022
Mailing address
17824 N US HIGHWAY 41, LUTZ, FL 33549-4502
(813) 948-1020
(813) 948-1022
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT22249
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12098575
CAQH
FL
01
—
169-9988006
INDIVIDUAL NPI
FL
01
—
CZ108A
PTAN
FL
Enumeration date
09/12/2011
Last updated
07/12/2018
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