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
Last updated
Oct 24, 2025By the provider in NPPES
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003903261. Details of each certification follow.

  • CCN 686545 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 686545

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LEADING EDGE PHYSICAL THERAPY & SPORTS INC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Apr 6, 1998
Last certification
Sep 11, 2023
Ownership / control type
Proprietary
Facility address
801 S Florida Ave
Lakeland, FL 33801

National Provider Directory

National Provider Directory

Locations

3647 Innovation Dr
Lakeland, FL 33812
Phone (863) 646-5000

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

500 S Florida Ave
Ste 16
Lakeland, FL 33801

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

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

101 6th St NW
Winter Haven, FL 33881
Phone (863) 299-4551

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

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

Verify at the official NPI Registry.