MEDICARE: HILLSBOROUGH THERAPY 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	261Q00000X	Clinic/Center	HCC10797	FL

General Provider Information

NPI Number	:	1205373123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLSBOROUGH THERAPY CENTER INC

Provider Business Mailing Address
First Line	:	6105 MEMORIAL HWY
Second Line	:	SUITE S
City	:	TAMPA
State	:	FL
Zip	:	33615-4597
Country	:	US
Telephone Number	:	813-964-6825
Fax Number	:	813-964-6829

Provider Business Practice Location Address
First Line	:	6105 MEMORIAL HWY
Second Line	:	SUITE S
City	:	TAMPA
State	:	FL
Zip	:	33615-4597
Country	:	US
Telephone Number	:	813-964-6825
Fax Number	:	813-964-6829

Authorized Official
Title or Position	:	OWNER
Name	:	JORGE LUIS LLANES
Credential	:
Telephone Number	:	813-964-6825

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	01/30/2017

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