MEDICARE: TOTAL BODY REHAB AND WEIGHT LOSS MANAGEMENT CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1063720357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL BODY REHAB AND WEIGHT LOSS MANAGEMENT CENTER, LLC

Provider Business Mailing Address
First Line	:	2011 W CLEVELAND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1756
Country	:	US
Telephone Number	:	813-373-5317
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 W CLEVELAND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1756
Country	:	US
Telephone Number	:	813-373-5317
Fax Number	:

Authorized Official
Title or Position	:	OWNER / MASSAGE THERAPIST
Name	:	MARIA A RAMOS
Credential	:	LMT
Telephone Number	:	813-373-5317

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	09/20/2010

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