Healthcare Provider Details

I. General information

NPI: 1467174557
Provider Name (Legal Business Name): NEUROPATHY GLOBAL PAIN CENTERS ST PETERSBURG FL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 9TH AVE N STE 150
ST PETERSBURG FL
33713-7146
US

IV. Provider business mailing address

7901 4TH ST N STE 10825
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 888-859-5343
  • Fax: 888-859-5343
Mailing address:
  • Phone: 888-859-5343
  • Fax: 888-859-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHTON MANHATTAN
Title or Position: FOUNDER
Credential:
Phone: 88-895-8534