Healthcare Provider Details

I. General information

NPI: 1679393276
Provider Name (Legal Business Name): DOL DOCTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5414 TOWN N COUNTRY BLVD
TAMPA FL
33615-4120
US

IV. Provider business mailing address

5414 TOWN N COUNTRY BLVD
TAMPA FL
33615-4120
US

V. Phone/Fax

Practice location:
  • Phone: 813-230-4410
  • Fax: 813-886-6959
Mailing address:
  • Phone: 813-230-4410
  • Fax: 813-886-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HILDA OBI-ANADIUME
Title or Position: MEMBER
Credential: DNP
Phone: 813-230-4410