Provider Demographics
NPI:1043728355
Name:LIVE STRONGER BUS
Entity Type:Organization
Organization Name:LIVE STRONGER BUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-466-8793
Mailing Address - Street 1:8602 TEMPLE TERRACE HWY
Mailing Address - Street 2:D-36
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-5802
Mailing Address - Country:US
Mailing Address - Phone:813-466-8793
Mailing Address - Fax:
Practice Address - Street 1:8602 TEMPLE TERRACE HWY
Practice Address - Street 2:D-36
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-5802
Practice Address - Country:US
Practice Address - Phone:813-466-8793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitationGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty