MEDICARE: BUSCH REHABILITATION CENTER 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1053881334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUSCH REHABILITATION CENTER INC.

Provider Business Mailing Address
First Line	:	2529 W BUSCH BLVD STE 900
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4524
Country	:	US
Telephone Number	:	813-512-7157
Fax Number	:

Provider Business Practice Location Address
First Line	:	2529 W BUSCH BLVD STE 900
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4524
Country	:	US
Telephone Number	:	813-512-7157
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ADRIAN ROLO ULLOA
Credential	:
Telephone Number	:	813-777-8436

Provider Enumeration Date	:	11/29/2018
Last Update Date	:	11/29/2018

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