Provider Demographics
NPI:1689819732
Name:PHYSICAL REHAB CENTER, INC
Entity Type:Organization
Organization Name:PHYSICAL REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:GALANG
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-870-1802
Mailing Address - Street 1:1936 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6500
Mailing Address - Country:US
Mailing Address - Phone:813-870-1802
Mailing Address - Fax:813-870-1815
Practice Address - Street 1:1936 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6500
Practice Address - Country:US
Practice Address - Phone:813-870-1802
Practice Address - Fax:813-870-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 67043261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation