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General NPI Number Information
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NPI Number | 1184159733
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Entity Type | Organization
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Legal Business Name | PASCO SPINE AND JOINT CARE LLC
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 16740 IVY LAKE DR
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City | ODESSA
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State | FL
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Zip | 33556-6020
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Country | US
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Telephone | 727-580-0658
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Fax | 813-925-9198
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Provider Business Mailing Address
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Address Line | 16740 IVY LAKE DR
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City | ODESSA
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State | FL
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Zip | 33556-6020
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Country | US
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Telephone | 727-580-0658
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Fax | 813-925-9198
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BARBARA MAGNANO
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Credential |
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Telephone | 727-580-0658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | OS 13047
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License Number State | FL
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Taxonomy #2
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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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