Healthcare Provider Details

I. General information

NPI: 1952220162
Provider Name (Legal Business Name): JOSUE CAMACHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 NORTHDALE BLVD STE 111W
TAMPA FL
33624-1853
US

IV. Provider business mailing address

14004 ROOSEVELT BLVD STE 613
CLEARWATER FL
33762-3819
US

V. Phone/Fax

Practice location:
  • Phone: 813-418-7350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTT44929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: