=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417196403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASCO HEALTH AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2009
-----------------------------------------------------
Last Update Date | 02/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27524 CASHFORD CIR SUITE 102
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544-6947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-333-6653
-----------------------------------------------------
Fax | 813-333-1204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29515 TANSY PASS
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33543-6582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. JUSTIN SPIEGEL
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 813-333-6653
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT 23432
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------