NPIMap

Organization Active NPI

Leading Edge Physical Therapy & Sports, Inc.

  • Physical Therapist
  • Lakeland, FL
National Provider Identifier
1003903261
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LEADING EDGE PHYSICAL THERAPY & SPORTS, INC.
Practice address
801 S Florida Ave Ste 5
Lakeland, FL 33801-5242
Phone
(863) 688-1800
Fax
(863) 688-1824
NPI assigned
Oct 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mike T Ryan, PHYSICAL THERAPIST
Title
Owner/ Physical Therapist
Phone
(863) 688-1800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

801 S Florida Ave Ste 5
Lakeland, FL 33801-5242

Mailing address

801 S Florida Ave Ste 5
Lakeland, FL 33801-5242
Phone (863) 688-1800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080731000246 FL Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 0547279416 Practice locations: Lakeland, FL

National Provider Directory

National Provider Directory

Locations

500 S Florida Ave
Ste 16
Lakeland, FL 33801

417 S Florida Ave
Lakeland, FL 33801
Phone (863) 688-1800

1507 Lakeland Hills Blvd
Ste 105
Lakeland, FL 33805
Phone (863) 688-1800

801 S Florida Ave
Ste 5
Lakeland, FL 33801
Phone (863) 688-1800

500 S Florida Ave
Ste 620
Lakeland, FL 33801
Phone 8636881800 ext. 112

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761264000000",
    "number": "1003903261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S FLORIDA AVE STE 5",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338015242",
            "telephone_number": "863-688-1800",
            "fax_number": "863-688-1824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S FLORIDA AVE STE 5",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338015242",
            "telephone_number": "863-688-1800",
            "fax_number": "863-688-1824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEADING EDGE PHYSICAL THERAPY & SPORTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/ PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "863-688-1800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.