Healthcare Provider Details

I. General information

NPI: 1568701837
Provider Name (Legal Business Name): OSCAR MEDELLIN JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35095 US HIGHWAY 19 N SUITE 101
PALM HARBOR FL
34684-2686
US

IV. Provider business mailing address

3903 NORTHDALE BLVD SUITE 111W
TAMPA FL
33624-1864
US

V. Phone/Fax

Practice location:
  • Phone: 727-475-5538
  • Fax: 727-771-2500
Mailing address:
  • Phone: 813-418-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: