Sport and Spine Physical Therapy and Wellness Center, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT22249 Issued in FL

Legal business name

SPORT AND SPINE PHYSICAL THERAPY AND WELLNESS CENTER, LLC

Practice address

17824 N US Highway 41
Lutz, FL 33549

Phone

(813) 948-1020

Fax

(813) 948-1022

NPI assigned

Sep 12, 2011

Organization subpart

No

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

Authorized official

Name

Ryan P Whelton, MSPT, DPT

Title

Owner

Phone

(813) 948-1020

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1629350137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17824 N US HIGHWAY 41",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335494502",
            "telephone_number": "813-948-1020",
            "fax_number": "813-948-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17824 N US HIGHWAY 41",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "33549",
            "telephone_number": "813-948-1020",
            "fax_number": "813-948-1022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT AND SPINE PHYSICAL THERAPY AND WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-12",
        "last_updated": "2018-07-12",
        "status": "A",
        "authorized_official_last_name": "WHELTON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-948-1020",
        "authorized_official_credential": "MSPT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "PT22249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "169-9988006",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12098575",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "CZ108A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dana Spears
• Lindsey Dambly Sperry, D.O.
• Braylee L Spiddle
• Carla Mae Spikowski, N.P.
• Hannah Spoo
• Sports and Orthopedic Rehabilitation Services, Inc. (Select Physical Therapy)
• Sports and Orthopedic Rehabilitation Services, Inc.
• Spyglass Enterprises, Inc.
• SRS Healthcare PLLC
• St Joseph's Diagnostic Center LLC (BayCare Outpatient Imaging)

• Physical Therapy Clinic/Center in Lutz, FL
• Providers in Lutz, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.