Healthcare Provider Details

I. General information

NPI: 1265074397
Provider Name (Legal Business Name): MEDERAPY HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 09/06/2023
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 N ARMENIA AVE
TAMPA FL
33604-5712
US

IV. Provider business mailing address

6424 N ARMENIA AVE
TAMPA FL
33604-5712
US

V. Phone/Fax

Practice location:
  • Phone: 305-804-1200
  • Fax:
Mailing address:
  • Phone: 305-804-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MIGUEL ANGEL LABRADA
Title or Position: PRESIDENT/OWNER
Credential: DPT
Phone: 305-772-1052