Healthcare Provider Details

I. General information

NPI: 1275671158
Provider Name (Legal Business Name): YOUNG PAIN AND REHAB CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 W WATERS AVE SUITE 12
TAMPA FL
33615-1599
US

IV. Provider business mailing address

7520 W WATERS AVE SUITE 12
TAMPA FL
33615-1599
US

V. Phone/Fax

Practice location:
  • Phone: 813-884-3773
  • Fax: 813-884-3855
Mailing address:
  • Phone: 813-884-3773
  • Fax: 813-884-3855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberMM 13883
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: YOUNG SOO SUH
Title or Position: P.T. DIRECTOR
Credential: P.T.
Phone: 813-884-3773