Provider Demographics
NPI:1619857273
Name:BIOSPORT PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:BIOSPORT PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:STAVRIANOUDAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:209-620-5554
Mailing Address - Street 1:PO BOX 576751
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6751
Mailing Address - Country:US
Mailing Address - Phone:209-524-7488
Mailing Address - Fax:209-522-7488
Practice Address - Street 1:1325 HISTORICAL PLAZA WAY
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5064
Practice Address - Country:US
Practice Address - Phone:209-524-7488
Practice Address - Fax:209-522-7488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOSPORT PHYSICAL THERAPY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty