Provider Demographics
NPI:1649595299
Name:BUSCHWOOD REHABILITATION LLC
Entity Type:Organization
Organization Name:BUSCHWOOD REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DINO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:813-932-8300
Mailing Address - Street 1:1502 W BUSCH BLVD
Mailing Address - Street 2:STE 1A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7668
Mailing Address - Country:US
Mailing Address - Phone:813-932-8300
Mailing Address - Fax:813-932-8303
Practice Address - Street 1:1502 W BUSCH BLVD
Practice Address - Street 2:STE 1A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7668
Practice Address - Country:US
Practice Address - Phone:813-932-8300
Practice Address - Fax:813-932-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 56282174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty