=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114145463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMPA BAY MEDICAL REHAB INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 09/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6800 N DALE MABRY HWY SUITE 198-B
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-3997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-935-1944
-----------------------------------------------------
Fax | 813-884-1955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6800 N DALE MABRY HWY SUITE 198-B
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-3997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-935-1944
-----------------------------------------------------
Fax | 813-884-1955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. YUSDANIA AMARO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-935-1944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME56636
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------