MEDICARE: ST ISABEL MEDICAL 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	261QP2000X	Physical Therapy Clinic/Center	MM23911	FL

General Provider Information

NPI Number	:	1326375122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST ISABEL MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	2901 W SAINT ISABEL ST STE E
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6350
Country	:	US
Telephone Number	:	813-443-4575
Fax Number	:	813-443-4578

Provider Business Practice Location Address
First Line	:	2901 W SAINT ISABEL ST STE E
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6350
Country	:	US
Telephone Number	:	813-443-4575
Fax Number	:	813-443-4578

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHOY P ESPOSITO
Credential	:	DC
Telephone Number	:	813-443-4575

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	11/16/2009

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