MEDICARE: FLORIDA INJURY CARE, 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	111NR0400X	Rehabilitation Chiropractor
2	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1821225798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA INJURY CARE, INC.

Provider Business Mailing Address
First Line	:	5700 MEMORIAL HWY STE#118
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615
Country	:	US
Telephone Number	:	813-889-9400
Fax Number	:	813-889-9440

Provider Business Practice Location Address
First Line	:	5700 MEMORIAL HWY STE 118
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-5260
Country	:	US
Telephone Number	:	813-889-9400
Fax Number	:	813-889-9440

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. EDILIO LOPEZ
Credential	:
Telephone Number	:	813-889-9400

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	06/17/2009

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