Provider Demographics
NPI:1386814366
Name:TOTAL ORTHOPEDIC REHABILITATION, INC
Entity Type:Organization
Organization Name:TOTAL ORTHOPEDIC REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-541-2112
Mailing Address - Street 1:1115 DR MARTIN LUTHER KING JUNIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584
Mailing Address - Country:US
Mailing Address - Phone:813-654-8585
Mailing Address - Fax:813-653-2965
Practice Address - Street 1:1115 DR MARTIN LUTHER KING JUNIOR BLVD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584
Practice Address - Country:US
Practice Address - Phone:813-654-8585
Practice Address - Fax:813-653-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55202OtherBCBS
FLU51674Medicare UPIN
FL55202ZMedicare PIN