Healthcare Provider Details

I. General information

NPI: 1225609803
Provider Name (Legal Business Name): PERFORMANCE HEALTH CLINICS OF TAMPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HENDERSON BLVD STE 307
TAMPA FL
33629-5021
US

IV. Provider business mailing address

3825 HENDERSON BLVD STE 307
TAMPA FL
33629-5021
US

V. Phone/Fax

Practice location:
  • Phone: 888-926-1223
  • Fax: 201-962-9068
Mailing address:
  • Phone: 888-926-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY BOBAL
Title or Position: MANAGING PARTNER
Credential: DC
Phone: 610-248-5273