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General NPI Number Information
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NPI Number | 1164062949
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Entity Type | Organization
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Legal Business Name | TAG PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 13908 LAKESHORE BLVD STE 210
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City | HUDSON
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State | FL
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Zip | 34667-1492
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Country | US
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Telephone | 727-379-2588
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Fax | 727-359-0333
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Provider Business Mailing Address
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Address Line | 13908 LAKESHORE BLVD STE 210
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City | HUDSON
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State | FL
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Zip | 34667-1492
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Country | US
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Telephone | 727-379-2588
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Fax | 727-359-0333
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Authorized Official
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Title or Position | MANAGER
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Name | HSIAOYUN HU
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Credential |
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Telephone | 727-379-2588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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