Provider Demographics
NPI:1881126654
Name:TAMPA BAY REHABILITATION CENTER INC
Entity type:Organization
Organization Name:TAMPA BAY REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOSVANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-862-7155
Mailing Address - Street 1:607 W MARTIN LUTHER KING BLVD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603
Mailing Address - Country:US
Mailing Address - Phone:813-231-0695
Mailing Address - Fax:813-231-0353
Practice Address - Street 1:607 W MARTIN LUTHER KING BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603
Practice Address - Country:US
Practice Address - Phone:813-231-0695
Practice Address - Fax:813-231-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10970261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service