Healthcare Provider Details

I. General information

NPI: 1013588482
Provider Name (Legal Business Name): LYRA ESCOBAR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 MARBELLA PLAZA DR
TAMPA FL
33619-7906
US

IV. Provider business mailing address

1240 MARBELLA PLAZA DR
TAMPA FL
33619-7906
US

V. Phone/Fax

Practice location:
  • Phone: 813-341-2726
  • Fax: 813-341-2755
Mailing address:
  • Phone: 813-341-2726
  • Fax: 813-341-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: