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General NPI Number Information
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NPI Number | 1063279479
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SERVICES PHYSIOTHERAPY & WELLNESS CENTER
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 500 VONDERBURG DR STE 105
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City | BRANDON
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State | FL
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Zip | 33511-5968
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Country | US
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Telephone | 904-800-8789
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846
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City | RIVERVIEW
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State | FL
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Zip | 33568-0846
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEVIN C BENTON
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Credential |
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Telephone | 813-474-4878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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