=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114403227
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBUST PAIN & WELLNESS MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2018
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8902 N DALE MABRY HWY SUITE 104
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-578-8500
-----------------------------------------------------
Fax | 813-680-0027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8902 N DALE MABRY HWY ST 104
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-578-8500
-----------------------------------------------------
Fax | 813-680-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ODAMIS RODRIGUEZ
-----------------------------------------------------
Credential | MASSAGE THERAPIES
-----------------------------------------------------
Telephone | 813-644-5644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------