Healthcare Provider Details

I. General information

NPI: 1003820978
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7274 55TH AVE E
BRADENTON FL
34203-8002
US

IV. Provider business mailing address

3820 NORTHDALE BLVD STE 101A
TAMPA FL
33624-1834
US

V. Phone/Fax

Practice location:
  • Phone: 941-752-4451
  • Fax:
Mailing address:
  • Phone: 813-264-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA PHILBECK
Title or Position: SR. GROUP BUSINESS MANAGER
Credential:
Phone: 813-264-7734