Provider Demographics
NPI:1508176868
Name:WESTCHASE PHYSICAL THERAPY & MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:WESTCHASE PHYSICAL THERAPY & MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CREADON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:813-434-3960
Mailing Address - Street 1:12625 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1331
Mailing Address - Country:US
Mailing Address - Phone:813-343-3960
Mailing Address - Fax:813-343-3965
Practice Address - Street 1:4969 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4813
Practice Address - Country:US
Practice Address - Phone:813-443-4716
Practice Address - Fax:813-443-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5810261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation