MEDICARE: GSA REHABILITATION & PAIN MANAGEMENT

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	225100000X	Physical Therapist	PT8073	FL

General Provider Information

NPI Number	:	1699048447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GSA REHABILITATION & PAIN MANAGEMENT

Provider Business Mailing Address
First Line	:	10511 CORAL KEY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3461
Country	:	US
Telephone Number	:	813-926-8701
Fax Number	:	813-333-1127

Provider Business Practice Location Address
First Line	:	1045 W BUSCH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-7703
Country	:	US
Telephone Number	:	813-918-5878
Fax Number	:	813-333-1127

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. AVELINO T GARCIA
Credential	:	PTA
Telephone Number	:	813-918-5880

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	02/09/2012

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