Healthcare Provider Details

I. General information

NPI: 1164520813
Provider Name (Legal Business Name): THERAOPTIMA INHOME REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7775 MOKENA CT
NEW PORT RICHEY FL
34654-5647
US

IV. Provider business mailing address

7775 MOKENA CT
NEW PORT RICHEY FL
34654-5647
US

V. Phone/Fax

Practice location:
  • Phone: 727-723-5480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7605
License Number StateFL

VIII. Authorized Official

Name: AGNES VERGARA
Title or Position: OWNER
Credential:
Phone: 727-723-5480