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NPI Code Detail

MEDICARE: TAMPA PREMIER MEDICAL GROUP LLC

MEDICARE: TAMPA PREMIER MEDICAL GROUP 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
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1154281210
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAMPA PREMIER MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 4814 N HABANA AVE
Second Line :
City : TAMPA
State : FL
Zip : 33614-6871
Country : US
Telephone Number : 813-252-8637
Fax Number : 813-252-8637
Provider Business Practice Location Address
First Line : 4814 N HABANA AVE
Second Line :
City : TAMPA
State : FL
Zip : 33614-6871
Country : US
Telephone Number : 813-252-8637
Fax Number : 813-252-8637
Authorized Official
Title or Position : OWNER
Name : YERICA PEREZ
Credential :
Telephone Number : 813-252-8637
Provider Enumeration Date : 11/12/2025
Last Update Date : 11/12/2025

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