MEDICARE: DKB HEALTH LLC FYZICAL THERAPY AND BALANCE CENTER

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1023736550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DKB HEALTH LLC FYZICAL THERAPY AND BALANCE CENTER

Provider Business Mailing Address
First Line	:	1136 19TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-4146
Country	:	US
Telephone Number	:	727-504-5655
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 PARK ST N STE 101
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-4030
Country	:	US
Telephone Number	:	727-388-4688
Fax Number	:	727-388-6887

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MR. DANIEL J PLANTE
Credential	:
Telephone Number	:	277-388-4688

Provider Enumeration Date	:	08/19/2022
Last Update Date	:	11/23/2022

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