Provider Demographics
NPI:1679800775
Name:PHYSIOHEALTH AND REHAB, INC.
Entity Type:Organization
Organization Name:PHYSIOHEALTH AND REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA CLARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-920-4293
Mailing Address - Street 1:17900 HUNTING BOW CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5390
Mailing Address - Country:US
Mailing Address - Phone:813-920-4293
Mailing Address - Fax:813-920-4238
Practice Address - Street 1:17900 HUNTING BOW CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5390
Practice Address - Country:US
Practice Address - Phone:813-920-4293
Practice Address - Fax:813-920-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15246261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy