Provider Demographics
NPI:1710223532
Name:UNITED CEREBRAL PALSY OF TAMPA BAY, INC
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF TAMPA BAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAM DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:813-239-1179
Mailing Address - Street 1:2215 E HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4432
Mailing Address - Country:US
Mailing Address - Phone:813-239-1179
Mailing Address - Fax:813-237-3091
Practice Address - Street 1:2215 E HENRY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4432
Practice Address - Country:US
Practice Address - Phone:813-239-1179
Practice Address - Fax:813-237-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811441200Medicaid