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General NPI Number Information
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NPI Number | 1154624385
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE HEALTH OF TAMPA, LLC
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 1722 BRUCE B DOWNS BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-8640
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Country | US
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Telephone | 813-929-3700
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Fax | 813-929-3711
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Provider Business Mailing Address
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Address Line | 1722 BRUCE B DOWNS BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-8640
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Country | US
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Telephone | 813-929-3700
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Fax | 813-929-3711
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN BERNS
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Credential |
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Telephone | 813-929-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8992
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS11335
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | OS11335
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License Number State | FL
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