Healthcare Provider Details

I. General information

NPI: 1497553077
Provider Name (Legal Business Name): LEHEAL BIOGENIX HQ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 W SWANN AVE
TAMPA FL
33606-2483
US

IV. Provider business mailing address

8310 REVELS RD
RIVERVIEW FL
33569-4724
US

V. Phone/Fax

Practice location:
  • Phone: 813-505-6921
  • Fax:
Mailing address:
  • Phone: 813-505-6921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: STACEY HEALD
Title or Position: CEO
Credential:
Phone: 813-505-6921