Provider Demographics
NPI:1790319119
Name:THIRD PHASE MEDICAL, LLC DBA PHYSICAL THERAPY NOW, PINELLAS PARK
Entity Type:Organization
Organization Name:THIRD PHASE MEDICAL, LLC DBA PHYSICAL THERAPY NOW, PINELLAS PARK
Other - Org Name:PHYSICAL THERAPY NOW, LARGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-275-7668
Mailing Address - Street 1:6709 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5728
Mailing Address - Country:US
Mailing Address - Phone:727-914-6343
Mailing Address - Fax:727-914-6341
Practice Address - Street 1:6709 49TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5728
Practice Address - Country:US
Practice Address - Phone:727-914-6343
Practice Address - Fax:727-914-6341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXT PHASE MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-25
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty