Healthcare Provider Details

I. General information

NPI: 1336721075
Provider Name (Legal Business Name): WESLEY CHAPEL SPINE & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20433 BRUCE B DOWNS BLVD
TAMPA FL
33647-2759
US

IV. Provider business mailing address

20433 BRUCE B DOWNS BLVD
TAMPA FL
33647-2759
US

V. Phone/Fax

Practice location:
  • Phone: 813-994-0151
  • Fax:
Mailing address:
  • Phone: 813-994-0151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON M BROOKS
Title or Position: OWNER
Credential: DC
Phone: 813-994-0151