MEDICARE: FUERZA PHYSICAL THERAPY, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1396412045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUERZA PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	401 N ROME AVE APT 4306
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-0050
Country	:	US
Telephone Number	:	816-462-8565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 N MARION ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-2638
Country	:	US
Telephone Number	:	816-462-8565
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SAMANTHA R GACH
Credential	:	DPT
Telephone Number	:	816-462-8565

Provider Enumeration Date	:	08/29/2021
Last Update Date	:	08/29/2021

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