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General NPI Number Information
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NPI Number | 1679800775
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Entity Type | Organization
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Legal Business Name | PHYSIOHEALTH AND REHAB, INC.
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 17900 HUNTING BOW CIR SUITE 102
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City | LUTZ
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State | FL
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Zip | 33558-5390
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Country | US
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Telephone | 813-920-4293
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Fax | 813-920-4238
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Provider Business Mailing Address
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Address Line | 17900 HUNTING BOW CIR SUITE 102
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City | LUTZ
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State | FL
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Zip | 33558-5390
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Country | US
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Telephone | 813-920-4293
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Fax | 813-920-4238
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Authorized Official
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Title or Position | CEO
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Name | MS. MARIA CLARISSA MARQUINEZ
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Credential | PT
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Telephone | 813-920-4293
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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 | PT15246
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License Number State | FL
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