MEDICARE: SUNCOAST BRAIN BALANCE LLC

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1043183890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST BRAIN BALANCE LLC

Provider Business Mailing Address
First Line	:	3051 TECH DR N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33716-1001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11902 RACE TRACK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3107
Country	:	US
Telephone Number	:	813-749-0872
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ADAM SCHOENBAUM
Credential	:
Telephone Number	:	727-458-9374

Provider Enumeration Date	:	09/27/2025
Last Update Date	:	12/10/2025

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