Healthcare Provider Details

I. General information

NPI: 1063991875
Provider Name (Legal Business Name): PHYSICAL MEDICINE & REHAB CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 DUCK SLOUGH BLVD STE 102
TRINITY FL
34655-5071
US

IV. Provider business mailing address

16734 IVY LAKE DR
ODESSA FL
33556-6020
US

V. Phone/Fax

Practice location:
  • Phone: 813-459-7711
  • Fax: 813-235-4175
Mailing address:
  • Phone: 813-459-7711
  • Fax: 813-235-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: J DAVID BARR
Title or Position: OWNER
Credential: PA
Phone: 813-459-7711