=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518500263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVUS PAIN & PHYSICAL MEDICINE - FLORIDA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2019
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1507 S TUTTLE AVE
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-722-0484
-----------------------------------------------------
Fax | 833-903-0130
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 157 BALTIMORE ST STE 102
-----------------------------------------------------
City | CUMBERLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21502-2472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-722-0484
-----------------------------------------------------
Fax | 833-903-0130
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | HEATHER ROBOSSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-727-3995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------