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General NPI Number Information
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NPI Number | 1902104854
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Entity Type | Organization
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Legal Business Name | PROREHAB MANAGEMENT LLC
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 4313 W NORTH A ST APT 2
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City | TAMPA
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State | FL
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Zip | 33609-2135
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Country | US
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Telephone | 813-766-9135
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Fax |
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Provider Business Mailing Address
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Address Line | 4313 W NORTH A ST. #2
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City | TAMPA
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State | FL
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Zip | 33609
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Country | US
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Telephone | 813-766-9135
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANDREW SEGOTIER
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Credential | P.T.
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Telephone | 813-766-9135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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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 | 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 #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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