MEDICARE: BACK-RUBS TO GO, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1013124437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK-RUBS TO GO, INC.

Provider Business Mailing Address
First Line	:	20500 COT RD
Second Line	:	# 458
City	:	LUTZ
State	:	FL
Zip	:	33558-5100
Country	:	US
Telephone Number	:	813-948-4923
Fax Number	:	813-948-4923

Provider Business Practice Location Address
First Line	:	20500 COT RD
Second Line	:	# 458
City	:	LUTZ
State	:	FL
Zip	:	33558-5100
Country	:	US
Telephone Number	:	813-948-4923
Fax Number	:	813-948-4923

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	FRANK VIZZONE
Credential	:	LMT
Telephone Number	:	813-948-4923

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/22/2020

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