Provider Demographics
NPI:1417150343
Name:P&G MEDICAL REH CENTER INC.
Entity Type:Organization
Organization Name:P&G MEDICAL REH CENTER INC.
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:V
Authorized Official - Last Name:PUJOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-935-8001
Mailing Address - Street 1:2901 W BUSCH BLVD STE 801
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4570
Mailing Address - Country:US
Mailing Address - Phone:813-935-8001
Mailing Address - Fax:813-935-8948
Practice Address - Street 1:2901 W BUSCH BLVD STE 801
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4570
Practice Address - Country:US
Practice Address - Phone:813-935-8001
Practice Address - Fax:813-935-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM14475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty