| Organization Name: | THERAPY SPORT MEDICAL CORP |
| NPI Number: | 1023392297 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HISELA M CASTRO (PRESIDENT) |
| Mailing Address: | 6555 Nw 36th St Suite 214 Virginia Gardens |
| State: | FL US |
| Postal Code: | 331666978 |
| Phone Number: | 3055268229 |
| Fax Number: | 3055268230 |
| NPI Enumeration Date: | 10/05/2011 |
| NPI Last Update Date: | 10/05/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | HCC9145 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |