Provider Demographics
NPI:1790016152
Name:TLC MEDICAL REHAB LLC
Entity Type:Organization
Organization Name:TLC MEDICAL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOONEY SOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-238-4900
Mailing Address - Street 1:829 W MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3309
Mailing Address - Country:US
Mailing Address - Phone:813-238-4900
Mailing Address - Fax:813-238-4910
Practice Address - Street 1:829 W MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3309
Practice Address - Country:US
Practice Address - Phone:813-238-4900
Practice Address - Fax:813-238-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7960261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service