Healthcare Provider Details

I. General information

NPI: 1487885737
Provider Name (Legal Business Name): FLORIDA WELLNESS AND REHAB PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 WEST LINEBAUGH AVE.
TAMPA FL
33624
US

IV. Provider business mailing address

4104 WEST LINEBAUGH AVE.
TAMPA FL
33624
US

V. Phone/Fax

Practice location:
  • Phone: 813-229-2225
  • Fax: 813-221-2225
Mailing address:
  • Phone: 813-229-2225
  • Fax: 813-221-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN JOHN UNGER
Title or Position: OWNER/CEO
Credential: DC
Phone: 727-264-8888