Provider Demographics
NPI:1114083946
Name:WESTCHASE PHYSICAL THERAPY AND MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:WESTCHASE PHYSICAL THERAPY AND MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:813-343-3960
Mailing Address - Street 1:12705 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1314
Mailing Address - Country:US
Mailing Address - Phone:813-343-3960
Mailing Address - Fax:813-343-3965
Practice Address - Street 1:12705 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1314
Practice Address - Country:US
Practice Address - Phone:813-343-3960
Practice Address - Fax:813-343-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7776919OtherAETNA
FLY924JOtherBCBS
FL5977700001Medicare NSC
FL7776919OtherAETNA