Healthcare Provider Details

I. General information

NPI: 1942487640
Provider Name (Legal Business Name): PASCO C.O.R.F., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37104 CLINTON AVE
DADE CITY FL
33525-5911
US

IV. Provider business mailing address

37104 CLINTON AVE
DADE CITY FL
33525-5911
US

V. Phone/Fax

Practice location:
  • Phone: 352-521-0002
  • Fax: 352-521-5958
Mailing address:
  • Phone: 352-521-0002
  • Fax: 352-521-5958

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: MRS. DEBORAH A KNICKERBOCKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-521-0002