Provider Demographics
NPI:1063879427
Name:ATHLETIX REHAB AND RECOVERY, LLC
Entity type:Organization
Organization Name:ATHLETIX REHAB AND RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARIF
Authorized Official - Middle Name:
Authorized Official - Last Name:TABBAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:203-550-0799
Mailing Address - Street 1:60 SW 13TH ST
Mailing Address - Street 2:UNIT 4005
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4328
Mailing Address - Country:US
Mailing Address - Phone:203-550-0799
Mailing Address - Fax:
Practice Address - Street 1:60 SW 13TH ST
Practice Address - Street 2:UNIT 4005
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-4328
Practice Address - Country:US
Practice Address - Phone:203-550-0799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29301225100000X
FL27956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty