Healthcare Provider Details

I. General information

NPI: 1558456236
Provider Name (Legal Business Name): WEST FLORIDA ORTHOPEDIC REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 HENDERSON BLVD STE A
TAMPA FL
33609-4515
US

IV. Provider business mailing address

PO BOX 271681
TAMPA FL
33688-1681
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-6664
  • Fax: 813-877-8799
Mailing address:
  • Phone: 813-935-9355
  • Fax: 813-932-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name: PARINITA SHANTA SMITH
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 813-877-6664