Healthcare Provider Details

I. General information

NPI: 1689819732
Provider Name (Legal Business Name): PHYSICAL REHAB CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 W DR MARTIN LUTHER KING JR BLVD SUITE 206
TAMPA FL
33607-6500
US

IV. Provider business mailing address

1936 W DR MARTIN LUTHER KING JR BLVD SUITE 206
TAMPA FL
33607-6500
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-1802
  • Fax: 813-870-1815
Mailing address:
  • Phone: 813-870-1802
  • Fax: 813-870-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberME 67043
License Number StateFL

VIII. Authorized Official

Name: DR. EMMANUEL GALANG ACOSTA
Title or Position: PRESIDENT
Credential: M.D
Phone: 813-870-1802