Provider Demographics
NPI:1043671852
Name:THERAPY CENTER OF TAMPA LLC
Entity type:Organization
Organization Name:THERAPY CENTER OF TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:8133-252-8446
Mailing Address - Street 1:3434 W COLUMBUS DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1860
Mailing Address - Country:US
Mailing Address - Phone:813-252-8446
Mailing Address - Fax:813-252-8453
Practice Address - Street 1:3434 W COLUMBUS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1860
Practice Address - Country:US
Practice Address - Phone:813-252-8446
Practice Address - Fax:813-252-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty