Healthcare Provider Details

I. General information

NPI: 1134456684
Provider Name (Legal Business Name): 7520 REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 W WATERS AVE STE 14
TAMPA FL
33615-1599
US

IV. Provider business mailing address

7520 W WATERS AVE STE 14
TAMPA FL
33615-1599
US

V. Phone/Fax

Practice location:
  • Phone: 813-443-4559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: ELIGER ALFONSO
Title or Position: OWNER
Credential:
Phone: 813-443-4559