Provider Demographics
NPI:1114145463
Name:TAMPA BAY MEDICAL REHAB INC.
Entity Type:Organization
Organization Name:TAMPA BAY MEDICAL REHAB INC.
Other - Org Name:TAMPA BAY MEDICAL CARE GROUP INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YUSDANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-935-1944
Mailing Address - Street 1:6800 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 198-B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3997
Mailing Address - Country:US
Mailing Address - Phone:813-935-1944
Mailing Address - Fax:813-884-1955
Practice Address - Street 1:6800 N DALE MABRY HWY
Practice Address - Street 2:SUITE 198-B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3997
Practice Address - Country:US
Practice Address - Phone:813-935-1944
Practice Address - Fax:813-884-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
FLME56636208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty