=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497251979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VETS LIFTING VETS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2018
-----------------------------------------------------
Last Update Date | 04/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9056 QUAIL CREEK DR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33647-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-637-6176
-----------------------------------------------------
Fax | 813-315-6104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9056 QUAIL CREEK DR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33647-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-637-6176
-----------------------------------------------------
Fax | 813-315-6104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | DEVORRIS RUSSELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-637-6176
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225CX0006X
-----------------------------------------------------
Taxonomy Name | Orientation and Mobility Training Rehabilitation Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------