MEDICARE: PHYSICAL REHAB CENTER, INC

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	261QR0400X	Rehabilitation Clinic/Center	ME 67043	FL

General Provider Information

NPI Number	:	1689819732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL REHAB CENTER, INC

Provider Business Mailing Address
First Line	:	1936 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 206
City	:	TAMPA
State	:	FL
Zip	:	33607-6500
Country	:	US
Telephone Number	:	813-870-1802
Fax Number	:	813-870-1815

Provider Business Practice Location Address
First Line	:	1936 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 206
City	:	TAMPA
State	:	FL
Zip	:	33607-6500
Country	:	US
Telephone Number	:	813-870-1802
Fax Number	:	813-870-1815

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EMMANUEL GALANG ACOSTA
Credential	:	M.D
Telephone Number	:	813-870-1802

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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