Provider Demographics
NPI:1568789816
Name:LIBERTY GROUP REHAB SERVICES INC
Entity Type:Organization
Organization Name:LIBERTY GROUP REHAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-402-2903
Mailing Address - Street 1:2601 N HIMES AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2112
Mailing Address - Country:US
Mailing Address - Phone:813-402-2903
Mailing Address - Fax:813-402-2913
Practice Address - Street 1:2601 N HIMES AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2112
Practice Address - Country:US
Practice Address - Phone:813-402-2903
Practice Address - Fax:813-402-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8095261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center