Healthcare Provider Details

I. General information

NPI: 1336305226
Provider Name (Legal Business Name): INJURY REHAB SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 W HILLSBOROUGH AVE
TAMPA FL
33614-5757
US

IV. Provider business mailing address

3611 W HILLSBOROUGH AVE
TAMPA FL
33614-5757
US

V. Phone/Fax

Practice location:
  • Phone: 813-319-2223
  • Fax: 813-319-2227
Mailing address:
  • Phone: 813-319-2223
  • Fax: 813-319-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2551
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME9182
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA15529
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH8024
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL VISHER
Title or Position: VP
Credential:
Phone: 813-319-2223