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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