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General NPI Number Information
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NPI Number | 1013167774
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Entity Type | Organization
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Legal Business Name | BACK2SLEEP, LLC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 08/16/2015
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Provider Practice Location Address
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Address Line | 12875 COMMODITY PL
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City | TAMPA
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State | FL
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Zip | 33626-3104
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Country | US
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Telephone | 813-377-5416
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Fax | 253-799-3853
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Provider Business Mailing Address
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Address Line | 303 MAIN ST UNIT 143
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-9706
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Country | US
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Telephone | 813-377-5416
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Fax | 253-799-3853
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WALTER MATTHEW GROTEKE
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Credential |
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Telephone | 813-377-5416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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