Prestige Sports and Regenerative Medicine LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PRESTIGE SPORTS AND REGENERATIVE MEDICINE LLC

Practice address

3800 W Broward Blvd Ste 101
Ft Lauderdale, FL 33312-1018

Phone

(469) 915-4211

Fax

(954) 820-4479

NPI assigned

Oct 7, 2024

Organization subpart

No

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

Authorized official

Name

Emir Khattak

Title

Credentialing Manager

Phone

(469) 485-3166

Specialties & licenses 1

Addresses

Other names 2

• PRESTIGE CONCIERGE PT-OT-SLP AND RT Doing business as
• PRESTIGE SPORTS AND REGENERATIVE MEDICINE LLC Doing business as

Practitioners 2

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

• Samuel Adolfo Rivera

  • Physical Therapist
  • Miramar, FL
  • NPI 1912637158
  NPD
• Henry Odazie, FNP-C

  • Family Nurse Practitioner
  • Oakland Park, FL
  • NPI 1740880848
  NPD (past)

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

{
    "created_epoch": "1728259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1750100723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 W BROWARD BLVD STE 101",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333121018",
            "telephone_number": "954-787-5234",
            "fax_number": "954-820-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 W BROWARD BLVD STE 101",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333121018",
            "telephone_number": "469-915-4211",
            "fax_number": "954-820-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE SPORTS AND REGENERATIVE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-07",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "KHATTAK",
        "authorized_official_first_name": "EMIR",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "469-485-3166"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRESTIGE CONCIERGE PT-OT-SLP AND RT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRESTIGE SPORTS AND REGENERATIVE MEDICINE LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRESTIGE SPORTS AND REGENERATIVE MEDICINE LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Prestige Cardiology Associates LLC
• Prestige Clinicians -Laboratory LLC
• Prestige Obstetrics and Gynecology Associates LLC
• Prestige Physicians LLC
• Prestige Recovery and Suboxone Clinic LLC
• Xaviera Preston, CNA
• Prevail Healthcare of FL
• Anthony P Previte, M.D.
• Christopher Price
• Jennahvie Prieto

• Physical Therapist in Ft Lauderdale, FL
• Providers in Ft Lauderdale, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; 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.