Provider Demographics
NPI:1285091942
Name:SOS PHYSIO LLC
Entity type:Organization
Organization Name:SOS PHYSIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORZHEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-306-8376
Mailing Address - Street 1:3575 NE 207TH ST STE B17
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3705
Mailing Address - Country:US
Mailing Address - Phone:305-306-8376
Mailing Address - Fax:305-306-8373
Practice Address - Street 1:3575 NE 207TH ST STE B17
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3705
Practice Address - Country:US
Practice Address - Phone:305-306-8376
Practice Address - Fax:305-306-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30534261QP2000X
207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty