Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 111NS0005X | Chiropractor | Sports Physician | | | No |
| 2 | 207RS0010X | Internal Medicine | Sports Medicine | | | No |
| 3 | 207XX0004X | Orthopaedic Surgery | Foot and Ankle Surgery | | | No |
| 4 | 2080S0010X | Pediatrics | Sports Medicine | | | No |
| 5 | 213EP1101X | Podiatrist | Primary Podiatric Medicine | | | No |
| 6 | 213ES0000X | Podiatrist | Sports Medicine | | | Yes |
| 7 | 213ES0103X | Podiatrist | Foot & Ankle Surgery | | | No |
| 8 | 213ES0131X | Podiatrist | Foot Surgery | | | No |
| 9 | 225100000X | Physical Therapist | | | | No |
| 10 | 2251S0007X | Physical Therapist | Sports | | | No |
| 11 | 225700000X | Massage Therapist | | | | No |
| 12 | 225XP0019X | Occupational Therapist | Physical Rehabilitation | | | No |
| 13 | 363LF0000X | Nurse Practitioner | Family | | | No |