Healthcare Provider Details

I. General information

NPI: 1629347554
Provider Name (Legal Business Name): PREMIER REHAB THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 WISHART BLVD
TAMPA FL
33603-2836
US

IV. Provider business mailing address

4417 WISHART BLVD
TAMPA FL
33603-2836
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-5902
  • Fax: 813-879-7800
Mailing address:
  • Phone: 813-879-5902
  • Fax: 813-879-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA 65389
License Number StateFL

VIII. Authorized Official

Name: ALEXIS LLAMOSA
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 813-879-5902