Organization
EMERALD HILLS REHABILITATION CENTER INC
Active
Other names
The SPORT Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MICHAEL SHAPIRO PT (PRESIDENT)
(954) 989-5255
Entity
Organization
Contact information
Practice address
3850 SHERIDAN STREET, HOLLYWOOD, FL 33021
(954) 989-5255
(954) 962-6445
Mailing address
3850 SHERIDAN STREET, HOLLYWOOD, FL 33021
(954) 989-5255
(954) 962-6445
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT19559
FL
225100000X
Physical Therapist
PT2021
FL
225100000X
Physical Therapist
PT22241
FL
225100000X
Physical Therapist
PT32161
FL
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1131310
UNITED HEALTHCARE
FL
01
—
2072908
AETNA HMO
FL
01
—
228790
AVMED
FL
01
—
372531000
US DEPARTAMENT OF LABOR
FL
01
—
4565667
AETNA PPO
FL
01
—
K1489
MEDICARE PTAN
FL
01
—
Y914R
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/21/2006
Last updated
01/08/2013
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