Provider Demographics
NPI:1639407638
Name:LISSMART REHABILITATION OF TAMPA,INC
Entity Type:Organization
Organization Name:LISSMART REHABILITATION OF TAMPA,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISVET
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-888-7177
Mailing Address - Street 1:8130 W WATERS AVE
Mailing Address - Street 2:130
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1821
Mailing Address - Country:US
Mailing Address - Phone:813-888-7177
Mailing Address - Fax:813-888-7110
Practice Address - Street 1:8130 W WATERS AVE
Practice Address - Street 2:130
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1821
Practice Address - Country:US
Practice Address - Phone:813-888-7177
Practice Address - Fax:813-888-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7865261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation