Provider Demographics
NPI:1033448030
Name:MEDICAL & REHAB CHOICE LLC
Entity Type:Organization
Organization Name:MEDICAL & REHAB CHOICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMANTIDES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-443-4727
Mailing Address - Street 1:3104 W WATERS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2800
Mailing Address - Country:US
Mailing Address - Phone:813-443-4727
Mailing Address - Fax:813-443-4728
Practice Address - Street 1:3104 W WATERS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2800
Practice Address - Country:US
Practice Address - Phone:813-443-4727
Practice Address - Fax:813-443-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7836261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service