Provider Demographics
NPI:1275671158
Name:YOUNG PAIN AND REHAB CENTER, INC
Entity Type:Organization
Organization Name:YOUNG PAIN AND REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:SOO
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-884-3773
Mailing Address - Street 1:7520 W WATERS AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1599
Mailing Address - Country:US
Mailing Address - Phone:813-884-3773
Mailing Address - Fax:813-884-3855
Practice Address - Street 1:7520 W WATERS AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1599
Practice Address - Country:US
Practice Address - Phone:813-884-3773
Practice Address - Fax:813-884-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM 13883261QP2000X
302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Not Answered302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6059OtherBLUECROSS-BLUESHIELD
FLY6059ZMedicare ID - Type Unspecified