Healthcare Provider Details

I. General information

NPI: 1306662119
Provider Name (Legal Business Name): MR. SEAN MEBANE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 INTERBAY BLVD
TAMPA FL
33611-4918
US

IV. Provider business mailing address

6515 INTERBAY BLVD
TAMPA FL
33611-4918
US

V. Phone/Fax

Practice location:
  • Phone: 727-642-5309
  • Fax:
Mailing address:
  • Phone: 727-642-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA19371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: