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General NPI Number Information
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NPI Number | 1548991524
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Entity Type | Organization
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Legal Business Name | HEALTHCARE STRAIGHT UP
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 840 NEWBERGER RD
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City | LUTZ
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State | FL
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Zip | 33549-4024
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Country | US
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Telephone | 727-824-0989
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Fax |
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Provider Business Mailing Address
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Address Line | 7661 FOUNTAIN AVE APT 2
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City | LOS ANGELES
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State | CA
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Zip | 90046-4028
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Country | US
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Telephone | 813-417-0505
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KELLY GOBLE
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Credential |
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Telephone | 813-417-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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