Healthcare Provider Details

I. General information

NPI: 1447923099
Provider Name (Legal Business Name): DIESEL HEALTH AND RECOVERY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 WEST CARMEN STREET
TAMPA FL
33606-1303
US

IV. Provider business mailing address

1202 WEST CARMEN STREET
TAMPA FL
33606-1303
US

V. Phone/Fax

Practice location:
  • Phone: 813-254-3707
  • Fax: 813-337-0357
Mailing address:
  • Phone: 813-254-3707
  • Fax: 813-337-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMIE LYNNE BRUNET
Title or Position: OWNER
Credential: DC
Phone: 813-254-3707