Healthcare Provider Details

I. General information

NPI: 1891025151
Provider Name (Legal Business Name): ER REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2010
Last Update Date: 01/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 HENDERSON BLVD
TAMPA FL
33609-4501
US

IV. Provider business mailing address

3619 HENDERSON BLVD
TAMPA FL
33609-4501
US

V. Phone/Fax

Practice location:
  • Phone: 813-874-6500
  • 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: RAFAEL A FRIAS
Title or Position: OWNER
Credential:
Phone: 813-874-6500