Provider Demographics
NPI:1548310030
Name:M-R S SPORT MEDICINE INC
Entity type:Organization
Organization Name:M-R S SPORT MEDICINE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:QUESTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-417-3866
Mailing Address - Street 1:5994 SW 18TH ST STE D7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7102
Mailing Address - Country:US
Mailing Address - Phone:561-417-3866
Mailing Address - Fax:561-417-3854
Practice Address - Street 1:5994 SW 18TH ST STE D7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7102
Practice Address - Country:US
Practice Address - Phone:561-417-3866
Practice Address - Fax:561-417-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686522Medicare Oscar/Certification