Provider Demographics
NPI:1235371022
Name:FLORIDA REHABILITATIONI PRACTICE, INC.
Entity Type:Organization
Organization Name:FLORIDA REHABILITATIONI PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ TEJADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-935-3334
Mailing Address - Street 1:2901 W BUSCH BLVD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4523
Mailing Address - Country:US
Mailing Address - Phone:813-935-3334
Mailing Address - Fax:813-935-3337
Practice Address - Street 1:2901 W BUSCH BLVD
Practice Address - Street 2:SUITE 610
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4523
Practice Address - Country:US
Practice Address - Phone:813-935-3334
Practice Address - Fax:813-935-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 4406261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service