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General NPI Number Information
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NPI Number | 1649432576
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Entity Type | Organization
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Legal Business Name | PELVIC REHABILITATION OF TAMPA LLC
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 13049 W LINEBAUGH AVE SUITE 102
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City | TAMPA
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State | FL
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Zip | 33626-4451
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Country | US
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Telephone | 813-854-1625
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Fax | 813-855-4396
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Provider Business Mailing Address
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Address Line | 13049 W LINEBAUGH AVE SUITE 102
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City | TAMPA
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State | FL
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Zip | 33626-4451
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Country | US
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Telephone | 813-854-1625
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Fax | 813-855-4396
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MRS. SHAYNE ELIZABETH TARRANCE
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Credential | P.T.
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Telephone | 813-854-1625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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