Provider Demographics
NPI:1568701837
Name:MEDELLIN, OSCAR JR (DPT)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:MEDELLIN
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 NORTHDALE BLVD
Mailing Address - Street 2:SUITE 111W
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1864
Mailing Address - Country:US
Mailing Address - Phone:813-418-7350
Mailing Address - Fax:
Practice Address - Street 1:35095 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2686
Practice Address - Country:US
Practice Address - Phone:727-475-5538
Practice Address - Fax:727-771-2500
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist