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General NPI Number Information
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NPI Number | 1144636861
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Entity Type | Organization
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Legal Business Name | WEECARE FOR KIDS PA
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 11948 BALM RIVERVIEW RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-6601
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Country | US
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Telephone | 813-236-9000
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Fax | 813-236-9002
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Provider Business Mailing Address
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Address Line | 11948 BALM RIVERVIEW RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-6601
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Country | US
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Telephone | 813-236-9000
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Fax | 813-236-9002
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER SUE THOLE
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Credential | MD
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Telephone | 813-236-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME82918
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License Number State | FL
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