MEDICARE: ORTHO IMPULSA 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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1811535719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO IMPULSA LLC

Provider Business Mailing Address
First Line	:	4450 E FLETCHER AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-4907
Country	:	US
Telephone Number	:	813-241-1414
Fax Number	:	813-336-2112

Provider Business Practice Location Address
First Line	:	4450 E FLETCHER AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-4907
Country	:	US
Telephone Number	:	813-241-1414
Fax Number	:	813-336-2112

Authorized Official
Title or Position	:	OWNER/FOUNDER
Name	:	GENE JASON HUNT
Credential	:	DO
Telephone Number	:	813-241-1414

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	12/11/2019

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Directions to “ORTHO IMPULSA LLC ” Practice Location

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