Provider Demographics
NPI:1154960573
Name:BRAINSPORT
Entity type:Organization
Organization Name:BRAINSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:X
Authorized Official - Last Name:CONIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-337-7272
Mailing Address - Street 1:2525 BURNS RD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5204
Mailing Address - Country:US
Mailing Address - Phone:772-337-7272
Mailing Address - Fax:772-337-7734
Practice Address - Street 1:2525 BURNS RD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5204
Practice Address - Country:US
Practice Address - Phone:772-337-7272
Practice Address - Fax:772-337-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0010XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySports MedicineGroup - Single Specialty